_Management of Preeclampsia and Eclampsia先兆子痫和子痫患者的麻醉管理课件.ppt

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_Management of Preeclampsia and Eclampsia先兆子痫和子痫患者的麻醉管理课件.ppt

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_Management of Preeclampsia and Eclampsia先兆子痫和子痫患者的麻醉管理课件

Regional vs. General Anesthesia in Preeclampsia Epidural anesthesia would probably be preferred by many anesthesiologists in a severely preeclamptic pt in a non-urgent setting For urgent cases it is reassuring to know that spinal is also safe This allows us to avoid general anesthesia with the potential for encountering a swollen, difficult airway and/or labile hypertension Regional vs. General Anesthesia in Preeclampsia General anesthesia is a well-known hazard in obstetric anesthesia: 16X more likely to result in anesthetic-related maternal mortality Mostly due to airway/respiratory complications, which would only be exaggerated in preeclampsia Hawkins, Anesthesiology 1997;86:273 Platelets Regional Anesthesia in Preeclampsia Prior to placing regional block in a preeclamptic it is recommended to check the platelet count. No concrete evidence at to the lowest safe platelet count for regional anesthesia in preeclampsia Any clinical evidence of DIC would contraindicate regional In the absence of such signs, most anesthesiologists would proceed at plt count 100K, many would proceed at 80-100K, 80K some would proceed (esp. spinal) Platelets Regional Anesthesia in Preeclampsia When placing a regional block in a patient with a platelet count 100K, the most important thing is to monitor resolution of block closely Bleeding time has been discredited as an indicator of epidural bleeding risk and is not indicated. Channing-Rogers, Semin Thromb Hemost 1990;16:;1-30 Low-dose aspirin is not a contraindication to regional anesthesia in preeclampsia CLASP study: 1422 women on aspirin received epidurals without any bleeding complications Hazards of General Anesthesiain Preeclampsia Airway edema is common Mandatory to reexamine the airway soon before induction Edema may appear or worsen at any time during the course of disease tongue facial, as well as laryngeal Laryngoscopy and intubation may ? severe ?BP Labetolol NTG are commonly used acutely Fentanyl (2.5 mcg/kg), alfe