急诊剖宫产的麻醉选择和术中处理.pptVIP

CSE √ Rapid onset and density of spinal anesthesia combined with versatility of epidural anesthesia Low-dose spinal reduce the incidences of cardiovascular instability especially useful in high risk cardiac patients CSE × Inability to test epidural catheter 18% rate of failure extra time consumption General anesthesia 15% of CS was performed under general anesthesia in US Majority of CS were done under urgent or emergent situations Indications for GA Fetal distress Significant coagulopathy Acute maternal hypovolemia and Homodynamic instability Sepsis or local skin infection failed regional anesthesia Maternal refusal of regional anesthesia GA √ Rapid onset Controlled airway and ventilation hands are free for fluid management and hemodynamics control in cases of major bleeding Almost never fails Minimal cooperation needed from the patient GA × 17 X higher anesthesia related mortality compared to regional anesthesia Risk of difficult/failed intubation 10 X higher than in non-obstetric population Risk of pulmunary aspiration Contribute to uterine relaxation/atony Extra time needed at end of procedure to wake up the the patient Usually faster onset of postoperative pain Risk of malignant hyperthermia Risk of intaoperative awareness Exposure of fetus to depressant effect of GA More costly Most important causes of mortality due to GA Inability to intubate Inability to ventilate Aspiration pneumonitis Suggested Technique for Cesarean Section The patient is placed supine with a wedge under the right hip for left uterine displacement. Preoxygenation 100% O2 3–5 min The patient is prepared and draped for surgery a rapid-sequence induction with cricoid pressure propofol, 2 mg/kg (or thiopental 4 mg/kg) succinylcholine, 1.5 mg/kg Ketamine, 1 mg/kg, is used instead of thiopental in hypovolemic or asthmatic patients. Suggested Technique for Cesarean Section Surgery is begun only after proper placement of the endotracheal tube is confirmed by capno