脊髓麻醉和重症妊娠高血压课件.pptVIP

Spinal Anesthesia and Severe Gestational Hypertension Dr. Alison Macarthur Department of Anesthesia University of Toronto Outline Review of population / current obstetric practices Methods of anesthesia for cesarean delivery (past / present) Suggestions for future practice Classification of PIH Incidence of Complicated Gestational Hypertension Incidence of GH: (U.S. 1979 - 86) 26 / 1000 live births contrast this with other nations: 20.3 / 1000 live births (Taiwan 1993-97) 103 / 1000 live births (Turkey 1986) Incidence of severe disease: 5.2 / 1000 live births (U.S. 1986) 7.8 / 1000 live births (Taiwan 1993-7) Incidence of Gestational Hypertension Incidence of eclampsia: 0.56 / 1000 live births (U.S.) 19 / 1000 live births (Turkey) Mortality: (U.S. 1979 - 92) 1.5 / 100,000 live births Spinal anesthesia - introduction into practice Obstetric anesthesiologists started using spinal anesthesia for cesarean delivery (1990’s) in mild - moderate disease change from 1st to 2nd ed. Chestnut’s Obstetric Anesthesia: “Some anesthesiologists consider spinal anesthesia contraindicated in preeclampsia because of the risk of severe hypotension.”… Old Evidence Hood - Hemodynamic results Wallace - Hemodynamic results Karinen - Fetal Outcome (Pulsatility index) New Evidence SOAP 2001; A34 Spinal Anesthesia for Eclamptics No. of antepartum eclamptic parturients requiring immediate delivery: 1505 / 1846 (81.5%) No. of cesarean deliveries: 1185 / 1505 (78.7%) Spinal Anesthesia for Eclamptics Method of anesthesia for cesarean delivery: 915 / 1185 spinal anesthesia (77.2%) 270 / 1185 general anesthesia (22.8%) Spinal Anesthesia for Eclamptics No. of deaths amongst women requiring LSCS delivery: 58 / 1505 (3.9%) [total deaths = 176 / 1846 (9.5%) ] Spinal Anesthesia for Eclamptics No. 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 Anesthes