脊髓麻醉和重癥妊娠高血壓課件

脊髓麻醉和重癥妊娠高血壓1OutlineReview

of

population

/

currentobstetric

practicesMethods

of

anesthesia

for

cesareandelivery

(past

/

present)Suggestions

for

future

practiceWallace

-

HemodynamicresultsKarinen

- Fetal

Outcome(Pulsatility

index)New

EvidenceSOAP

2001;

A34Spinal

Anesthesia

forEclampticsNo.

of

antepartum

eclamptic

parturientsrequiring

immediate

delivery:1505

/

1846

(81.5%)No.

of

cesareandeliveries:1185

/

1505

(78.7%)Spinal

Anesthesia

forEclampticsMethod

of

anesthesia

forcesarean

delivery:915

/

1185

spinalanesthesia(77.2%)270

/

1185

general

anesthesia(22.8%)Spinal

Anesthesia

forEclampticsNo.

of

deaths

amongstwomenrequiring

LSCS

delivery:58

/

1505

(3.9%)[total

deaths

= 176/

1846 (9.5%)

]Spinal

Anesthesia

forEclampticsNo.

of

deaths

by

method

of

anesthesia:spinal=31/

915(3.4%)general=27/

270(10%)Odds

Ratio

(general

/

spinal)3.17 (95%

C.I.

1.86,

5.41)Spinal

Anesthesia

for

Eclamptics

-Remaining

Questions?What

factors

determined

type

ofanesthetic?What

were

the

causes

of

death

in

each

group?Where

there

complications

in

each

group?Not

all

the

women

with

antepartum

eclampsia(1846)

delivered(1505). What

happened

tothese

women?New

EvidenceRegional

Anesthesia

and

Pain

Medicine2001;

26:

46-51Ramanathan

-

StudyMethodsDesign:

case

series

of

46women,severe

preeclampsia

receiving

CSEforcesarean

deliveryIntervention:

intrathecal

bupivicaine7.5

mg+

fentanyl

25mcg(+

epidurallidocaine

2%)Ramanathan

-

StudyMethodsOutcomes:

BP,

Ephedrine

doses,Apgar

score,

umb

ABGResults:8%

epidural

supplementation

/

34%

priorto

closuremedian

sensory

level

T4(T2-T5)52%

req’d

ephedrine

use,

nadir

w/i

5

minofspinalRamanathan

-

HemodynamicchangesSBPDBPMAPComments:

Dr.

HoodOral

exam

preparation:

does

the

clinicalscenario

leave

time

for

anepidural?Urgent

clinical

scenario:

spinal

anestheticResidents

taught

to

use

spinal

anesthesia2/3

attendants

@

2000

OAA

meeting

usespinal

anestheticsPersonal

PearlsChoosing

patient:

consider

airway,

bleedingdiathesis,

neurological

status,

urgencyMethods:hyperbaric

bupivicaine

0.75%

11.25-13.5mgpreservative-free

morphine

0.1-0.2mgConsiderintra-arterialmonitorPre-determine

%

change

in

MAP

orsystolicbp

to

respond

withvasopressorConclusionsFuture

research:

AwaitRCT……h(huán)owever…….

Changing

obstetric

practice:327

/

444

(73.6%)

laboredLack

of

clinical

equipoise:“.....we

could

not

do

a

randomised

epiduralversusspinal

trial

for

severe

pre-eclamptics.”Future

StudiesSophisticated

evaluation

of

fetal

/neonatal

wellbeing

during

course

ofregional

anesthesiaContinued

reporting

ofobservationaldata

(specifically:

morbidity)Conclusion…

are

not

to

convince

thatspinalanesthesia

should