脊髓麻醉和重症妊娠高血压教学文稿.ppt

In this figure, from Hood’s 1999 retrospective study, are displayed the mean arterial pressure results for the two groups during cesarean delivery. 103 parturients had spinal anesthesia and are represented by the open circles while 35 parturients had epidural anesthesia and are represented by the closed circles. Hood attempted to identify from each patient’s chart the lowest MAP from three time periods: prior to administration of regional block, from administration of block to delivery, and then following delivery. As you can see, the two groups’ average lowest mean arterial pressures at the three points in time were not different. This figure depicts the mean arterial pressure during cesarean delivery amongst the three different anesthetic groups in Wallace’s randomised clinical trial, epidural, CSE and general anesthesia. The only time point where the three groups were significantly different was at skin incision, where the group receiving general anesthesia had significantly greater MAP than either regional group. Within each group, all types of anesthetic had reductions in MAP when compared to the baseline MAP on arrival in the O.R. There were no significant differences in average lowest MAP among the three groups. This figure depicts the assessment of maternal uterine artery flow by measurement of the pulsatility index (systolic peak velocity - end diastolic velocity / mean velocity during cardiac cycle) around the time of anesthetic induction. Increases in the pulsatility index represent moments where systolic arterial pressures fell. Along the y-axis is the mean + 95% CI changes in pulsatility index from baseline. There were no significant changes over time. The S symbol represents time point of spinal anesthesia induction. 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