急诊剖宫产的麻醉选择和术中处理.pptVIP

急诊剖宫产的 麻醉选择和术中处理 费敏 2010-3-26 Definition Abdominal delivery a surgical procedure that permits delivery of the infant through incisions in the abdominal and uterine wall. Cesarean Section Caedere –Seco Pompilius II 730 BC not widely used until the 1920s Indications for Cesarean Section Repeat Scheduled Failed attempt at vaginal delivery Dystocia Abnormal presentation Transverse lie Breech Multiple gestation Fetal stress/distress Deteriorating maternal medical illness Preeclampsia Heart disease Pulmonary disease Hemorrhage Placenta previa Placental abruption Cesarean Section 60% unplanned More extensive peripartum monitoring Lower threshold for surgical intervention What is an ‘emergency’ Caesarean section? -Category 1 2 Category 1 Indication Placental abruption uterine rupture???? cord prolapse?? Actively bleeding placenta praevia Intrapartum hemorrhage Presumed fetal compromise with severely abnormal CTG and/or severe fetal acidosis The 30-minute rule a maximum decision-to-delivery time of 30 min for Category 1 situation Association of Anaesthetists of Great Britain and Ireland and ObstetricAnaesthesists’ Association. Guidelines for obstetric anaesthesia services; 2005. Hillemanns P, Strauss A, Hasbargen U, et al. Crash emergency cesarean section: decision-to-delivery interval under 30 min and its effect on Apgar and umbilical artery pH. Arch Gynecol Obstet 2005; 273:161–165. anaesthetist informed – delivery Perianesthetic Evaluation A directed history and physical examination platelet count An intrapartum blood type and screen for all parturients reduces maternal complications Perianesthetic recording of the fetal heart rate reduces fetal and neonatal complications A directed history and physical examination Maternal health and anesthetic history Relevant obstetric history Airway and heart and lung examination Baseline blood pressure Back examination when neuraxial anesthesia is planned or placed Platelet c