ResumoContexto: Embora seja um problema crescente na população mundial, existem poucos trabalhos publicados sobre o uso de drogas durante a gravidez. Objetivos: Abordar de maneira objetiva as drogas de abuso (álcool, cocaína, maconha e tabaco) mais comumente utilizadas pelas mulheres em idade reprodutiva. Métodos: Foi realizada revisão bibliográfica (MEDLINE, LILACS) dos textos mais recentes abordando o uso de drogas de abuso em mulheres em idade reprodutiva. Resultados: Foram descritas as principais conseqüências da utilização de drogas de abuso, tanto para a mãe quanto para o bebê. Conclusões: Trata-se de um problema de saúde pública pouco discutido, devendo envolver uma equipe multidisciplinar em sua abordagem. A publicação de mais trabalhos se faz necessária, a fim de se estabelecer a melhor estratégia de intervenção nesta população.Yamaguchi, E.T. et al. / Rev. Psiq. Clín 35, supl 1; 44-47, 2008 Palavras-chave: Gravidez, drogas, álcool, cocaína, maconha, tabaco. AbstractBackground: Despite the fact that it has being a growing problem worldwide, very few works and papers have been published on drug use during pregnancy. Objectives: To objectively address the most commonly abused drugs (alcohol, cocaine, marijuana, and tobacco) by women of a reproductive age. Methods: A literature review (MEDLINE, LILACS) of the most recent papers on drug abuse by women of reproductive age was carried out. Results: The primary consequences of drug abuse both for the mother and the infant are described. Conclusions: This is a little discussed major public health issue which requires the involvement of a multidisciplinary team. The publication of a greater number of papers on the problem is necessary in order to establish the best strategy for addressing intervention in this population.

The incidence of chronic pain decreases with higher doses of local anesthetics and use of anti-inflammatory drugs. The higher pain scores in the postoperative period were associated with chronic pain development after three months of cesarean section.

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BACKGROUND:Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section.METHODS:A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis.RESULTS:There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time.DISCUSSION AND CONCLUSIONS:No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

In the study sample, pregestational BMI ≥ 25 kg.m(-2) was a risk factor for hypotension after spinal anesthesia in patients undergoing cesarean section. The same group of patients required higher doses of vasopressors. Those results indicate that the anesthetic techniques in those patients should be improved to reduce the consequences of post-spinal anesthesia hypotension, both in pregnant women and fetuses.

Progesterone (P4) plays a key role in pregnancy establishment and maintenance; during early pregnancy, P4 stimulates the production and release of uterine secretions necessary for conceptus growth prior to implantation; therefore, exogenous P4 supplementation may improve embryo development. This study evaluated the effects of supplementation during early pregnancy with long-acting injectable progesterone or altrenogest on embryonic characteristics of sows and gilts. Thus, a total of 32 sows and 16 gilts were used. On day 6 of pregnancy sows and gilts were allocated to one of the following groups: non-supplemented; supplemented with 20 mg of altrenogest, orally, from days 6 to 12 of pregnancy; supplemented with 2.15 mg/kg of long-acting injectable progesterone on day 6 of pregnancy. Animals were killed on day 28 of pregnancy, and ovulation rate, embryo survival, embryo weight, crown-to-rump length, uterine glandular epithelium and endometrial vascularization were assessed. Treatments had no effect on pregnancy rate, embryo survival or endometrial vascular density (P > 0.05). Non-supplemented gilts presented larger and heavier embryos compared to gilts from supplemented groups (P < 0.05). Sows in the altrenogest group presented larger and heavier embryos compared to non-supplemented sows and sows supplemented with long-acting injectable progesterone. In conclusion, supplementation of sows and gilts with progestagen from day 6 of pregnancy can be used as a means to improve embryo survival without deleterious effects.

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PURPOSE:To investigate the myocardial ischemia-reperfusion with sevoflurane anesthetic preconditioning (APC) would present beneficial effects on autonomic and cardiac function indexes after the acute phase of a myocardial ischemia-reperfusion. METHODS:Twenty Wistar rats were allocated in three groups: control (CON, n=10), myocardial infarction with sevoflurane (SEV, n=5) and infarcted without sevoflurane (INF, n=5). Myocardial ischemia (60 min) and reperfusion were performed by temporary coronary occlusion. Twenty-one days later, the systolic and diastolic function were evaluated by echocardiography; spectral analysis of the systolic arterial pressure (SAPV) and heart rate variability (HRV) were assessed. After the recording period, the infarct size (IS) was evaluated. RESULTS:The INF group presented greater cardiac dysfunction and increased sympathetic modulation of the SAPV, as well as decreased alpha index and worse vagal modulation of the HRV. The SEV group exhibited attenuation of the systolic and diastolic dysfunction and preserved vagal modulation (square root of the mean squared differences of successive R-R intervals and high frequency) of HRV, as well as a smaller IS. CONCLUSION:Sevoflurane preconditioning better preserved the cardiac function and autonomic modulation of the heart in postacute myocardial infarction period.Key words: Autonomic Nervous System. Heart Rate. Myocardial Infarction. Ischemic Preconditioning, Myocardial. Rats. Sevoflurane preconditioning during myocardial ischemia-reperfusion reduces infarct size and preserves autonomic control of circulation in rats