Introduction: Postpartum hemorrhage is one of the main causes of maternal mortality. Objective: To characterize postpartum hemorrhage. Methods: A descriptive, longitudinal and prospective study was carried out in the Anesthesiology and Resuscitation service of Dr. Agostinho Neto Hospital, between 2015 and 2017. The study population was made up by 65 patients. The following variables were studied: biological age, gestational age, type of hemorrhage, estimated amount of bleeding, etiology, hemodynamic and clinical laboratory variables, fluid resuscitation and blood products replacement, complications. We used empirical methods (document analysis, instruments for the collection of information), theoretical methods (analysis, synthesis, induction, deduction), and mathematicalstatistical methods (percentage, mean, standard deviation and confidence intervals). Results: The average age of the patients was 24.2±6.2 years; the gestational age was 34.2±6.2 years; 73.8% completed the pregnancy by natural delivery, while the interval between delivery and the onset of postpartum hemorrhage was 2.46h±53 min. Uterine atony (61.5%) was the most common cause of hemorrhage. Shock was the most common complication (100%), which conditioned the use of high volumes of replacement fluids and blood products. Hysterectomy and ligation of hypogastric arteries was the most used surgical technique (52.3%). Conclusions: During the study period, postpartum hemorrhage was an important cause of morbidity and mortality in the Anesthesiology and Resuscitation service of Dr. Agostinho Neto Hospital.

Introduction: Total intravenous anesthesia is characterized by hemodynamic stability, anesthetic depth, rapid and predictable recovery, less medication and less toxicity. Objective: To describe the outcomes of total intravenous anesthesia in breast cancer surgery. Method: A descriptive, longitudinal study was carried out in Hermanos Ameijeiras Clinical-Surgical Hospital, from January 2016 to December 2016, in 100 patients who were administered total intravenous anesthesia with midazolam and fentanyl for breast oncology surgery. The patients were determined hemodynamic repercussion, the level of sedation, analgesia, recovery and complications. Results: The mean age of the patients was 58.99±12.5 years. Among the patients under study, 92% did not present clinical signs of superficiality. Only 21 patients presented complications. Variations in blood pressure were the most frequent (16%), followed by bradycardia or tachycardia in only four cases. Immediately, 74% of the cases were recovered and the remaining 26% did so timely. The level of sedation was adequate in 50% and excessive in 4%. Among the total number of cases, 99% experienced analgesic response without pain. Conclusions: The outcomes of total intravenous anesthesia usage were good, with adequate analgesic response and few complications.

Introduction: Enhanced or fast-track recovery protocols, nowadays, constitute a fundamental link when it comes to improving the quality of perioperative care provided to patients for reducing the incidence of complications. A fundamental section in them is related to the evaluation, optimization and timely nutritional support. Objective: To demonstrate the importance of adequate evaluation and timely perioperative nutritional support in patients scheduled for cardiac surgical procedures. Methods: We carried out a review of the literature related to the subject. Development: Malnutrition is one of the most important problems, as evidenced by a series of publications dating from 1976 to date. The evaluation of nutritional status must be carried out throughout the perioperative period. In its different phases, a series of risk factors are described and, when present, require the introduction of early and intensive parenteral and/or enteral nutritional support. Conclusions: The evaluation and preoperative optimization of the nutritional status is vital for an adequate perioperative evolution of patients, so it must be an indispensable part of the anesthesiological consultation. Nutritional support should be established early once the risk indicators have been identified, in order to reduce the incidence of perioperative complications.

Introduction: Critically ill care units report numerous cases of malnutrition. In order to estimate such statistics, it is necessary to use dietary, anthropometric, biochemical and immunological indicators. Objective: To characterize the nutritional status of postoperative patients admitted to an intensive care unit. Methods: A descriptive, prospective, cross-sectional study was carried out. The values were obtained from the indicators of the type anthropometric (average arm and calf circumference), biochemical (albumin, cholesterol, triglycerides and creatinine) and immunological (total lymphocyte count) of 98 patients admitted to the unit. The nutritional status was evaluated by independent variables. Results: Patients with 1-7 days of stay predominated (71.4%), mechanical ventilation was used in 33.6%, 19.3% of patients died, and the group of intraabdominal conditions predominated (38.8%). Lymphopenia (68.3%) and hypoalbuminemia (62.2%) were more significant, followed by average arm circumference (AAC) in the malnutrition range (47.9%). There was no association of nutritional variables with the stay, nor the need for mechanical ventilation. All the variables were associated with the state at the time of discharge. Conclusions: A stay of about one week predominated, one third of the sample required ventilatory support, and mortality was low. Among all the nutritional variables studied, no association was found with the stay or the use of mechanical ventilation, but instead with the state at discharge.

Introduction: Pain is a symptom as old as humanity itself and has been an inseparable part of it. Objective: To evaluate the effectiveness of preventive analgesia with diclofenac for postoperative pain in elective paediatric general surgery. Methods: A prospective, quasi-experimental study was carried out with 230 children who underwent elective general surgery. The sample was divided into two groups: preventive analgesia with diclofenac (study group) versus dipyrone by the rectal way (control group). The variables analyzed were pain intensity, hemodynamic modifications, clinical evolution and adverse events. Results: In both groups, patients aged 6-10 years of age prevailed. In the study group, pain onset occurred at 6 hours after surgery, in only 23 patients; not being that way in the control group, in which, at 4 hours, 19 patients reported pain. In the study group, the 23 patients had approximately 2 hours of pain duration and, among them, only 4 hours with severe intensity; while in the control group, 65 patients reported 2 hours of pain and the rest referred it for 4 hours despite the analgesic rescue. Nine of them presented severe intensity. Some patients presented changes in blood pressure, heart rate and breathing associated with pain. The frequent adverse effects include nausea and vomiting. Revista Cubana de Anestesiología y Reanimación 2019;18(2):e548 Esta obra está bajo una licencia https://creativecommons.org/licenses/by-nc/4.0/deed.es_ES 3 Conclusions: The preventive administration of diclofenac decreases the intensity of posoperative pain in surgical procedures of elective paediatric general surgery.

Introduction: Difficult airway Intubation is a health problem. To prevent it, different rate values have been used. Objective: To evaluate the usefulness of El-Ganzouri index for predicting the degree of difficulty in tracheal intubation by conventional laryngoscopy. Method: A descriptive, cross-sectional study was carried out with patients who needed tracheal intubation, in Hermanos Ameijeiras Hospital, between February 2014 and 2017. This test combines and stratifies seven variables derived from individually associated observational parameters. Their values were stratified and interpreted (below 4, easy airway; 4 or higher, difficult airway). Results: We studied 94 patients, in which the El-Ganzouri index was evaluated. The age group of 50-59 years (29.8%) and the male sex (52.1%) predominated. ASA II was more frequent, accounting for 66%. The El Ganzouri index prevailed the oral opening over 4 cm, the tiromentonian distance below 6.5 cm, the Mallamapati class was present in 91.5%, neck movements below 90°, body weight over 90 kg, and no antecedent of history of difficult intubation in 67.0%. Upon corroborating the predictive tests with that of Cormack and Lehane, it was observed that 92.6% of the patients had an easy airway and this condition was obtained in 78.7% with the El Ganzouri index. Sensitivity was 71.43% and specificity was 20.69%. The positive predictive value was 6.76, and the negative predictive value was 90.0. Conclusions: The usefulness of the multivariate El-Ganzouri risk index was confirmed for the prediction of the degree of difficulty in tracheal intubation by conventional laryngoscopy. Sensitivity, specificity, positive and negative predictive values were identified, which showed good prediction of anatomically difficult airway.

Introduction: Post-operative pain in upper thorax and hemiabdomen surgery has a solid neuropathic component; it is therefore associated with evolution towards chronic pain. On this basis, anticonvulsants are applied as part of the multimodal treatment. Objectives: To evaluate analgesic effectiveness and safety of gabapentin for management of pain after thorax and upper abdomen surgery. Method: A quasiexperimental, comparative and prospective study was conducted with the patients announced for surgery of the upper abdomen and thorax, in the period from 2015 to 2017. Thirty patients divided into 2 groups were included. The Group G (n=14) received treatment with gabapentin 100 mg orally the day before the intervention and every 12 h in the postoperative period until 24 h. The Group C (n=16) received the conventional analgesia prescribed for this type of intervention. Results: The sample was homogeneous regarding age and sex. Pain intensity levels were lower in the gabapentin group and this difference becomes more significant 24 hours after surgery. This corresponds to a lower need for rescue analgesia (71% vs. 100%). Associated complications were more frequent in the study group at the expense of nausea, although there were no significant differences. Conclusions: The use of gabapentin in the perioperative period guarantees better pain control with few complications.

K p v t q f w e v k qp< In Cuba, cancer is the leading cause of death at ages 15-64 and the second at ages over 65, digestive tumors occupy the third position among malignancies and pancreatic affection the fourth place among these. Q d l g e v k x g < To present the evolution of a patient with a pancreatic tumor and survival of more than 6 months who underwent neurolysis of the celiac plexus. E c u g " rt g u gpv c v k q p < A 64-year-old male patient diagnosed with adenocarcinoma of the body and tail of the pancreas without surgical criteria, with pain of severe intensity that made it impossible to start adjuvant treatment, for which he underwent neurolysis of the bilateral celiac plexus, with 7 mL of phenol-10% per side, through the retrocrural posterior space with follow-up with image intensifier, and oral adjuvant treatment was administered with tricyclic, analgesic and anxiolytic antidepressants due to the mixed component of oncological pain. E q p e n w u k q p u < The neurolytic block of the celiac plexus associated with conventional oral analgesic pharmacological therapy provided total relief of pain from pancreatic cancer in an immediate and lasting way. It was possible to improve the general state of the patient, which facilitates the start of adjuvant oncology therapy.

Beckwith Wiedemann syndrome is characterized by omphalocele, macroglossia, visceromegaly and neonatal hypoglycaemia, as well as a great diversity of clinical and laboratory abnormalities. This disease is also known as omphalocele, macroglossia and gigantism syndrome. The most significant problems related to anesthesia are hypoglycemia and macroglossia. It is imperative to perform a pre-anesthetic evaluation that includes the cardiovascular system, the urinary system, as well as the airway. Children with this syndrome may require different surgical procedures. A difficult approach to the airway should be predicted due to the growth of the tongue which can cause difficulty during ventilation and/or endotracheal intubation. Perioperative glycemia should be monitored in order to avoid neurological sequelae secondary to undiagnosed hypoglycemia. We report the perianesthesiological treatment of a four-year-old boy with Beckwith-Wiedemann syndrome who required surgical treatment for Wilms tumor. After a thorough evaluation, orotracheal intubation was performed with a 5.0 tube, which was easily introduced with ketamine-vecuronium induction. Anesthesia was maintained without incident with isoflurane and fentanyl.

Introducción: La cirugía video laparoscópica posee beneficios para los pacientes. Las intervenciones con tiempos reducidos implican técnicas anestésicas ajustadas a ellos, lo que determina no pocas dificultades cuando el dolor aparece en la práctica asistencial. El hallazgo de pacientes con dolor posoperatorio inmediato motivó la realización del estudio. Objetivo: Evaluar la efectividad de un opioide de acción rápida como analgésico posoperatorio inmediato administrado vía intranasal. Método: Se desarrolló un estudio causiexpereimental, con dos grupos de enfermos (100 cada uno) a los que se les realizó colecistectomía por vía laparoscópica en el Hospital Militar Central "Dr. Luis Díaz Soto", a los 100 pacientes en estudio se les administró FENTANYL 50 mcg intranasal en gotas al llegar a la sala de cuidados posoperatorios. Las variables de estudio incluyeron el dolor según la Escala Visual Análoga (EVA), el tiempo de inicio de acción del opioide y la analgesia lograda, así como los efectos derivados de su empleo. Resultados: la edad promedio fue 51 ± 2, predominó el sexo masculino con 55 % de los casos, se evidenció una EVA promedio de todos los casos iniciales en 3. Al alta, 100 % de los pacientes del grupo estudio poseían analgesia excelente (EVA 2), mientras que los controles poseían una EVA promedio en 5. El prurito fue el evento adverso más frecuente tras la administración de FENTANYL intranasal. Conclusiones: El empleo de un opioide de acción rápida (FENTANYL) es una medida de control del dolor posoperatorio excelente y segura.

Dice el dicho que "el tiempo pasa" … pero también que "recordar es volver a vivir". Con mucho gusto accedo a escribir este editorial en el que voy a intentar hacer un balance de algunos aspectos de los inicios de la Revista Cubana de Anestesiología y Reanimación en su versión digital. Desde hace muchos años la Sociedad Cubana de Anestesiología y Reanimación (SCAR) trabajó por tener una revista. Inicialmente se hizo un folleto titulado Actualidades en Anestesiología, en él se publicaron algunos trabajos originales y se tradujeron artículos de actualización divulgados en revistas internacionales. Los problemas inherentes al período especial no hicieron posible continuarlo. Posteriormente, se comenzó una segunda empresa, casi de forma clandestina (en el mejor sentido de la palabra); pues no había forma de lograr una plataforma donde se pudiera colocar la revista. Por nuestra insistencia, el Centro Nacional de Información Médica (Infomed) creó una red llamada AnestRed, en ella fue donde se publicaron los primeros números. La Revista Cubana de Anestesiología y Reanimación en su versión digital se inauguró oficialmente el 17 de octubre de 2002, en el marco de la V Jornada Nacional de la especialidad "Fernando Polanco" celebrada en el Hotel Meliá Varadero del 17 al 20 de octubre de dicho año. Se publicó con número de ISSN: 1726-6718, Expediente 347-01-01-E y RNPS 2004.

Introduction: One of the most feared emergencies during the instrumentation of the respiratory tract is bronchospasm. Magnesium sulfate, administered intravenously, has a bronchodilation effect by antagonizing calcium channels, inhibiting muscle contraction mediated by calcium and promoting bronchial smooth muscle relaxation. Objective: To evaluate the efficacy of magnesium sulfate administered intravenously in patients with bronchospasm during bronchoscopy. Methods: Observational, descriptive and cross-sectional study carried out with 20 patients, with bronchospasm, triggered by airway manipulation with flexible bronchoscope, treated with 50 mg/kg of magnesium sulfate, (maximum 2 g), administered intravenously for 5 min. Results: Men between 50-59 years (75 %) predominated. All patients were smokers. 15 patients were classified with physical state ASA III. They suffered bronchospasm of mild intensity 60 %, classified according to the clinic and monitoring of oxygen saturation. In 75 % of the patients, the bronchospasm ceased after the treatment without administering any other medication. No adverse effects were recorded. No patient needed orotracheal intubation for ventilation or required hospitalization for more than 8 hours. Conclusions: Magnesium sulfate is a good pharmacological option for the emergency treatment of bronchospasm triggered by manipulation of the respiratory tract.

Introduction: A series of brief distant ischemia periods can limit myocardial damage produced by ischemia or reperfusion. Objective: To analyze the differences between the two groups (control and study) taking into account the consumption of inotropics and/or vasopressors during the intraoperative and postoperative periods, as well as the incidence of major cardiac adverse events and mortality in the postoperative period. Methods: A quasiexperimental, explanatory and comparative study with historical control was conducted on two groups of 247 patients proposed for coronary revascularization. A tourniquet was placed to the right arm, in the study group, alternating three insufflations with three dessufflations with a pressure of 200 mmHg, keeping each for five minutes. This procedure was performed before, during and after the major ischemic event, caused by pinching of the coronary artery. Results: A significant decrease in the consumption of inotropic and vasoactive drugs was achieved. The decrease in the incidence of low reversible cardiac output, ventricular fibrillation, and new acute myocardial infarction was also proven. Conclusions: Distant ischemic conditioning is an important tool to be taken into account for perioperative cardiac protection in coronary revascularization.

El nombre completo de nuestra especialidad es Anestesiología y Reanimación, esa denominación acredita que una parte indisoluble del quehacer cotidiano es la reanimación en todas sus variantes, incluyendo la reanimación de la parada cardiorrespiratoria (PCR). Cabría analizar entonces, si es función del anestesiólogo actuar ante un paciente de muerte súbita cuando 70 % de estas se producen fuera de área hospitalaria y en múltiples ocasiones, cuando dentro de una institución se encuentra lejos físicamente. Esto puede ser un evento que atañe transversalmente a todo quien lo presencie.(1) Cuando ocurre una PCR, el inicio de las maniobras en forma precoz, oportuna y eficiente puede hacer la diferencia entre la vida y la muerte, en ocasiones de dos vidas, si la paciente es gestante y se encuentra a término. En el diseño curricular de la carrera de Medicina, Enfermería y Tecnología de la Salud, el aprendizaje de las maniobras de reanimación cardiopulmonar y cerebral (RCPC) es escaso. A partir de la implementación del Plan de estudio "D" de la carrera de Medicina, el estudio de la reanimación se ha resaltado. En las diversas residencias se trabaja poco, existen cursos específicos pero no se ha informado la ocurrencia de estos en muchas universidades o facultades.(2) La formación y actualización del personal sanitario que trabaja en servicios de urgencias está establecida cada dos años por la American Heart Association y la European Resuscitation Council.(3) La población general, independientemente de su calificación profesional y nivel cultural, debe ser capaz de aprender y realizar una RCPC básica efectiva.(4) Es común que la primera decisión ante una parada hospitalaria es requerir la presencia del anestesiólogo, algo en principio correcto para que a su llegada reoriente las conductas; pero en múltiples ocasiones sucede en un escenario donde nada se hace hasta que este llegue. Nuestra responsabilidad como expertos en el tema es permanecer al corriente de las recomendaciones actualizadas vigentes, así como mantener un permanente entrenamiento de las destrezas que se requieren para llevar a la práctica las acciones necesarias en forma exitosa. Sin duda constituye un hecho que la baja incidencia del PCR no permite mantener un nivel de entrenamiento de las destrezas requeridas para una correcta RCPC lo que lleva a la pérdida de estas, si alguna vez se adquirieron. En la gestante a la que se adiciona la posibilidad de la cesárea perimortem rodeada de un acto de osadía, que requiere un alto nivel de decisión por el imperativo de tener que realizarse en el lugar de ocurrencia, y en el tiempo previsto, o sea al quinto minuto del comienzo de la PCR.(5) Frente a la poca ocurrencia, la simulación es la principal herramienta para disminuir los errores, entre ellos, el retraso de la activación del equipo neonatal.(6) Esta mejora se traduce en rapidez y en el aumento de la tasa de partos exitosos,(7) además es un proceso que se debe sustentar en la autorregulación del aprendizaje.(8) Se hace necesario entonces, que la enseñanza de la RCP sea contemplada como una competencia que se entrene y evalúe periódicamente. Los anestesiólogos deben ser quienes lideren los grupos dedicados al tema, al mismo tiempo que se debe demostrar un elevado dominio de la competencia en reanimación toda vez que sea requerido, con actualización, habilidad y destrezas.

En el año 1973 la Organización Panamericana de Salud (OPS) declaró a Cuba libre de la enfermedad de paludismo, pero siempre hay riesgo de casos importados por cualquier país que tenga el vector y que reciba personas de áreas endémicas.(1) La malaria gestacional se define como la presencia de plasmodium en sangre periférica materna y en la placenta. Puede tener importantes repercusiones tanto para la madre como para el feto. Por lo tanto, es prudente para los anestesiólogos saber las implicaciones de la enfermedad.(2) La anemia por hemólisis es secundaria a la liberación de merozoitos y a la pérdida de la deformabilidad del hematíe. Constituye la primera causa de muerte materna. Cuando los niveles de hemoglobina estén por debajo de 7 g/dL o el hematocrito sea menor de 21 %, se procederá a la transfusión de concentrados de hematíes. Pueden aparecer alteraciones de la coagulación que precisen la transfusión de otros componentes sanguíneos.(3) La hipoglucemia es un signo de mal pronóstico de la enfermedad. Esta complicación puede desembocar en muerte materno-fetal. Hay que realizar una correcta hidratación con cuantificación de la diuresis y un estricto control de los niveles plasmáticos de glucosa, ya que los antipalúdicos pueden exacerbar las hipoglucemias por lo que se recomienda la infusión continua de dextrosa.(4) La malaria grave se reconoce cuando aparece: hiperparasitemia (> 50 000 parásitos/mm3 de sangre), malaria cerebral, anemia severa, acidosis láctica, hipoglucemia, ictericia, falla renal, hipertermia superior a 40,5 ºC y/o hiperémesis. En los casos de malaria cerebral se administrará fenobarbital a dosis única como profilaxis de las convulsiones. A menudo hay alteraciones de la coagulación o manifestaciones cerebrales que contraindican el uso de la anestesia espinal y por tanto, condicionaría a realizar una anestesia general.(5) La anestesia espinal tiene teóricamente riesgo de transportar eritrocitos con parásitos de malaria dentro del líquido cefalorraquídeo y desencadenar una malaria cerebral, pero es muy baja la probabilidad que esto ocurra.(6) Se requiere una monitorización estrecha: electrocardiografía, pulsioximetría, presión arterial invasiva y en caso de fracaso multiorgánico medidas de la presión capilar pulmonar y de enclavamiento mediante catéteres de Swan-Ganz. El cuidado posoperatorio de las pacientes con malaria gestacional se deberá realizar en unidades de cuidados intensivos para garantizar las medidas de apoyo multiorgánico, estas incluyen las terapias de protección renal, ventilación y administración de ionotrópicos.(7) Se concluye que la malaria obstétrica es una afección multisistémica con graves implicaciones orgánicas, por lo tanto, la interacción de la malaria con la técnica de anestesia utilizada dependerá en gran medida en el sistema de órgano afectado

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 %, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, Z= 6.0 significant; heart rate averages between 80 and 88 beats per minute, Z= 1.94 not significant; partial oxygen saturation with an average of 99.2 %. In 46.74 % ,43 cases the time of onset of analgesia was short, Z= 8.47, being good in 100% of the cases, Z= 6.89 significant; with vigorous newborn in 100 % Z= 10.25 significant. The evolution was satisfactory in 48.19 % of the patients. They presented pruritus 8.69 %. In group B, there was arterial hypertension in 2.17 % of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 % and it was good in 40.22 %. These patients showed less satisfaction, 41.30 %. Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor.

Introduction: Cardiac arrest in pregnant women and perimortem cesarean section are rare. These are medical catastrophes that require immediate attention. Performing this procedure according to adequate standards provides better options for both the mother and the fetus. Cuba pays special attention to the maternal-fetal binomial, for which large amounts of human and technological resources are used. Objective: To update the information about perimortem cesarean section. Methods: A database review was carried out to find epidemiological descriptions, case reports, case series, personal communications, and studies in different health contexts, which would serve as scientific evidence on the subject. Results: Cardiac arrest in pregnant women is a rare event; the performance of a perimortem cesarean section with reduced time (4-5 min) was an effective option. The work of the multidisciplinary team based on protocols has a function that benefits both the mother and the fetus. Currently, the concept of resuscitative hysterotomy is recommended, which reflects the optimization of the resuscitation efforts. Maternal death by anesthesia is a medical emergency that requires special attention. There are medical associations that advocate the scales of early care in pregnant women, with updated training and innovative strategies to obtain better outcomes. Conclusions: The study of cardiac arrest in pregnant women, perimortem caesarean section and anesthesia-related maternal death are important. The creation of multidisciplinary groups and well-trained groups are the best option in these circumstances. It is recommended to increase the study and training to offer the best options to the maternal-fetal binomial.