周捷产后出血的麻醉处理概要1.pptxVIP

产后出血的麻醉处理;Disclosure;Tonight on the Labor Floor…;In the Operating Room…;Objectives;Mortality from Postpartum Hemorrhage; 1995 through 2004 PPH increased by 30% 2.9 % of all deliveries Blood transfusion 2.4 to 4.6 per 1000 (90% increase) Uterine atony: predictable only 40% of cases. ;Cardiac Arrest During Hospitalization For Delivery in the United States, 1998-2011;United Kingdom;Objectives;Postpartum Hemorrhage Defined;Major Postpartum Hemorrhage;Objectives;Challenges of PPH;;The 4 T’s of PPH;Sliver RM et al; Obstet Gynecol 2006; 107(6): 1226-32;An atonic uterus is a bleeding uterus; ;;Uterotonic Agents for PPH;When pharmacologic treatment fails…;Objectives;Hemostasis ;Low Fibrinogen Predicts Worse Outcome In Postpartum Hemorrhage;www.R;Ducloy-Bouthors AS et al. Crit Care 2011. ;Tranexamic Acid for the Treatment of Postpartum Haemorrhage: an International Randomized, Double Blind, Placebo Controlled Trial;;Is there a perfect transfusion ratio? ;12,226 deliveries, 2006-2009 1.1% (142 patients) had severe PPH Higher FFP:PRBC ratio were less likely to have: - embolization - arterial ligation - hysterectomy;;Point-of-Care Testing: Thromboelastography;Hill JS et al. Anaesth Int Care 2012. ;Electronic Resources for Management of Postpartum Hemorrhage;;Just another day at the LD simulator… -Your laboring patient gets a labor epidural -The patient falls, breaking her femur! -To the OR for C/S. -Epidural dosed up ? total spinal! -Difficult airway! -Bradycardia, hypoxic cardiopulmonary arrest! ;Words Matter!;In the Operating Room…;Summary;Title Slide: Option 1