产科麻醉英文版（58页）.ppt

Anesthesia For Sesarean Section Choice depends on : the indications for the surgery the degree of urgency maternal status desires of the patient Spinal Anesthesia Hyperbaric bupivacaine Advantages : rapid onset, little risk of local anesthetic toxicity, minimal transfer to the fetus, infrequent failure. Disadvantages : finite duration hypotension headache Epidural Anesthesia L 2～3 or L 1～2 1.5%～2% Lidocaine or 0.5% Ropivacaine emergency cesarean section Combined Spinal-Epidural Technique Increased dramatically in popularity Advantages : rapid onset supplemented at any time anesthetic dose↓ sacral nerves block is sufficient General Anesthesia rapid induction: obviate positive pressure ventilation oppress the cricoid cartilage mainterance: light anesthesia vomiting, backstreaming and aspiration: atropine, 0.5 mg, IM or glycopyrolate, 0.2 mg, IM Supine hypotensive syndrome Incidence: 2%～30% Time: after 28 weeks, specially 32～36 weeks Symptoms: ◆ hypotension, ◆ dizziness, ◆ nausea, ◆ chest distress, ◆ cold sweat, ◆ to yawn, ◆ pulse rate↑, ◆ pallescence High risk pregnancy Emergency operation : late trimester of pregnancy: hemorrhage gestational hypertension syndrom and eclampsia Selective operation : hypertension cardiac disease diabetes multifetation Placenta Previa and Placental Abruption Preanesthtic preparation: blood coagulation function DIC sifting test acute renal failure Principle: general anesthesia: active bleeding, hypovolemic shock, definite blood coagulation disfunction or DIC intraspinal anesthesia: condition of mother and fetus is okay Management degrees of a