Continuous spinal anesthesia for cesarean section for a morbidly obese parturient patient: a case report

This case report details the successful anesthetic management of a morbidly obese parturient patient who presented for a repeat, elective cesarean section. The preanesthetic evaluation and the indications for choosing a continuous spinal anesthetic are discussed. Evaluation of the anesthetic plan is also discussed through a review of the postoperative scenario.     

Experience with combined spinal and epidural anesthesia at cesarean section

The paper analyzes some experience gained in using various modes of regional anesthesia as an anesthetic appliance at cesarean sections and comparatively characterizes various types of central segmental blocks. The results of 213 cases of cesarean section performed under spinal or combined spinal and epidural anesthesia (CSEA) were generalized by the following parameters: block onset, maternal and fetal action, the quality of anesthesia and postoperative analgesia, which leads to the conclusion that CSEA is the method of choice.     

Effective epidural anesthesia for cesarean section in parturient woman with type I mucopolysaccharidosis (Hurler's syndrome)

Mucopolysaccharidosis is genetically determined disease caused by the deficiency of one of the lysosomal enzymes involved in the glycosaminoglycan (GAG) breakdown pathway. This metabolic block leads to the accumulation of GAG in various organs and tissues and affects nerve system, eyes, internal organs and musculoskeletal system. The reviewer of various articles on pubmed showed only one article about epidural anesthesia in patient with type I mucopolysaccharidosis. Our observation allows to consider that epidural anesthesia with ropivacaine is possible and safe in patients with type I mucopolysaccharidosis.     

剖宫产腰麻后低血压防治措施的研究进展

单次腰麻现在已经成为目前世界范围内剖宫产麻醉最常用的技术。由于产妇孕期生理发生了一系列的改变,导致低血压是腰麻剖宫产术最常见的并发症。严重的、持续的低血压会导致产妇恶心呕吐、胸闷、呼吸困难甚至心脏骤停,还可以引起胎儿缺血缺氧甚至胎儿窘迫。因此,如何防治腰麻后低血压在剖宫产手术中显得尤为重要,这也是近年来产科麻醉研究的一个热点。     

休克体位在腰麻下剖宫产手术中的应用

腰麻具有操作简便、起效迅速、麻醉效果确切等优势,成为剖宫产手术麻醉的首选。目前临床上腰麻完成后多取头高脚低位以防止麻醉平面过高,但头高脚低位会造成下肢静脉回心血量的减少,增加了低血压的发生率和严重程度。为此,对该类手术的体位加以改进,对腰麻剖宫产术中采取休克体位,即中凹卧     

休克体位在腰麻下剖宫产手术中的应用

腰麻具有操作简便、起效迅速、麻醉效果确切等优势,成为剖宫产手术麻醉的首选。目前临床上腰麻完成后多取头高脚低位以防止麻醉平面过高,但头高脚低位会造成下肢静脉回心血量的减少,增加了低血压的发生率和严重程度。     

椎管内麻醉和全身麻醉对前置胎盘剖宫产产妇及新生儿的影响

目的探讨椎管内麻醉和全身麻醉对前置胎盘剖宫产产妇及新生儿的影响。方法选取我院收治的73例胎盘前置产妇,根据随机数字表法将其分为椎管内麻醉组(36例)和全身麻醉组(37例)。比较两组产妇的血流动力学指标、术中麻醉效果、产妇术中情况及新生儿情况。结果T1、T2、T3、T4时,两组产妇的MAP、HR均明显低于T0时,但全身麻醉组的MAP、HR均明显高于椎管内麻醉组,差异具有统计学意义(P<0.05);T1、T2、T3、T4时,两组产妇的Sp O2比较,差异无统计学意义(P>0.05)。全身麻醉组产妇术中麻醉效果优良率明显高于椎管内麻醉组,差异具有统计学意义(P<0.05)。全身麻醉组的手术时间明显长于椎管内麻醉组,术中出血量明显多于椎管内麻醉组,差异具有统计学意义(P<0.05)。两组新生儿的断脐时间、脐动脉血气分析相关指标及出生后1 min和5 min的Apgar评分比较,差异无统计学意义(P>0.05)。结论前置胎盘剖宫产术中行全身麻醉的效果较佳,且对产妇血流动力学影响小、不会影响新生儿安全,但会延长手术时间,增加术中出血量,故术前需给予产妇针对性处理。     

Comparison of three neuraxial anesthesia approaches in parturient women with obesity and pregnancy-induced hypertension who underwent cesarean section

ObjectiveTo compare the effectiveness of different approaches of neuraxial anesthesia in parturient women with obesity and pregnancy-induced hypertension (PIH) who undergo cesarean section (CS).MethodsWe retrospectively analyzed data from 108 parturient women with obesity and PIH who underwent CS. All women were divided into the following three groups according to the neuraxial anesthesia approach: spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal–epidural anesthesia (CSE). Clinical variables were compared.ResultsThe mean age of the patients was 27.3 ± 2.2 years. Women in the CSE group had a longer duration from puncture to surgery, smaller intraoperative change in mean arterial pressure, higher Apgar scores at 1 and 5 minutes, shorter surgery time, lower rates of nausea and vomiting, and lower rate of intraoperative hypotension compared with those in the SA and EA groups.ConclusionCSE takes longer to administer in parturient women with obesity and PIH who undergo CS compared with those who have SA or EA. However, CSE has several advantages over SA or EA, including a shorter surgery time, more stable intraoperative mean arterial pressure, lower rates of nausea, vomiting, and intraoperative hypotension, and better Apgar scores at 1 and 5 minutes.     

舒适护理在剖宫产产妇中的应用

目的:探讨舒适护理在剖宫产产妇中的应用效果.方法:将200例剖宫产手术患者随机分为观察组和对照组各100例,对照组实施常规护理,观察组实施舒适护理.比较两组护理后治疗效果和满意度.结果:观察组产妇不良心理状况及术后并发症发生率低于对照组(P<0.05),新生儿Apgar评分、产妇满意度及各项观察指标均优于对照组(P<0.05).结论:将舒适护理应用于剖宫产产妇中,产妇感觉舒适,满足了产妇及新生儿身心需要,提高了产妇对护理人员的满意度.     

去氧肾上腺素和麻黄碱在蛛网膜下腔麻醉下剖宫产术中纠正低血压的比较

目的 观察去氧肾上腺素和麻黄碱在蛛网膜下腔麻醉下剖宫产术时纠正低血压的效果.方法 选取100例术中使用升压药物的初产妇,随机分为两组(n=50):E组(麻黄碱组,8 mg/ml)和P组(去氧肾上腺素组,100μg/ml).记录麻醉前、麻醉后至手术结束两种药物的使用量、产妇血压、心率和呼吸的变化,同时记录产妇恶心、呕吐的情况.在胎儿娩出即刻,进行产妇动脉血、新生儿脐动脉血和脐静脉血气分析,分别测量肾上腺素、去甲肾上腺素、去氧肾上腺素和麻黄碱的浓度.对新生儿进行1 min和5 min Apgar评分.结果 (1)两种药物的等效使用量、纠正产妇血压和产妇呼吸的变化比较没有差异.(2)新生儿1 min和5 min Apgar评分比较无统计学差异.(3)产妇心率变化去氧肾上腺素组明显小于麻黄碱组(P<0.05),产妇恶心、呕吐去氧肾上腺素组明显小于麻黄碱组(P<0.05).(4)脐动脉和脐静脉pH、碱剩余,麻黄碱组明显低于去氧肾上腺素组(p<0.05),而脐动脉PC02和脐静脉的PO2麻黄碱组明显高于去氧肾上腺素组(P<0.05),脐动脉的肾上腺素和去甲肾上腺素的浓度麻黄碱组明显高于去氧肾上腺素组(P<0.05).结论 去氧肾上腺素在蛛网膜下腔麻醉下剖宫产术中纠正产妇低血压比麻黄碱更具优势.     

舒适护理在剖宫产分娩的应用

[目的]探讨舒适护理应用于剖宫产分娩的效果.[方法]将213例剖宫产分娩产妇随机分为实验组和对照组,对照组给予常规护理,实验组给予舒适护理. [结果]所有产妇均顺利分娩,实验组、对照组并发症发生率分别为7.4%、17.1%,两组比较差异有统计学意义.[结论]舒适护理应用于剖宫产产妇的护理中,能减少并发症的发生,提高护理效果.     

健康教育路径在择期剖宫产术产妇中的应用

[目的]探讨健康教育路径在择期剖宫产术产妇中的应用效果。[方法]将180例行择期剖宫产术分娩的产妇随机分为实验组和对照组各90例,对照组采用传统健康教育方式,实验组按照健康教育路径进行健康教育。[结果]两组住院时间、住院费用、产妇满意度和健康知识评分比较差异有统计学意义。[结论]健康教育路径的实施,使产妇接受系统、科学的医疗护理照护,可缩短住院时间,降低住院费用,提高产妇满意度和护理工作质量。     

健康教育路径在择期剖宫产术产妇中的应用

[目的]探讨健康教育路径在择期剖宫产术产妇中的应用效果.[方法]将180例行择期剖宫产术分娩的产妇随机分为实验组和对照组各90例, 对照组采用传统健康教育方式,实验组按照健康教育路径进行健康教育.[结果]两组住院时间、住院费用、产妇满意度和健康知识评分比较差异有统计学意义.[结论]健康教育路径的实施,使产妇接受系统、科学的医疗护理照护,可缩短住院时间,降低住院费用,提高产妇满意度和护理工作质量.     

Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system

Objective. To determine risk factors for developing hypotension after spinal anesthesia for cesarean section to prevent obstetric patients from hypotensive episodes potentially resulting in intrauterine malperfusion and endangering the child. Methods. The data from 503 women, having received spinal anesthesia for cesarean sections were investigated using online gathered vital signs and specially checked manual entries employing an anesthesia information management system. Blood pressure, heart rate, and oxygen saturation were measured throughout and hypotension was defined as either a drop in mean arterial blood pressure of >20% from baseline value or readings of <90 mmHg systolic arterial blood pressure. Thirty-two variables were studied for association with hypotensive episodes using univariate analysis and logistic regression employing a forward stepwise algorithm to identify independent variables (P < 0.05). Results. Hypotension was found in 284 cases (56.5%). The univariate analysis identified the neonate’s weight, mother’s age, body mass index, and peak sensory block height associated with hypotension. Body mass index, age and sensory block height were detected as independent factors for hypotension (odds-ratio: 1.61 each). Conclusions. Knowledge of these risk factors should increase the anesthesiologist’s attention to decide for the necessity to employ prophylactic or therapeutic techniques or drugs to prevent the neonate from any risk resulting of hypotension of the mother.     

三种麻醉方法用于剖宫产手术临床效果比较

目的比较单次硬膜外麻醉、腰-硬联合麻醉、连续硬膜外麻醉在剖宫产手术中的效果。方法急诊手术240例,随机分为3组,A组为单次硬膜外麻醉,B组为腰-硬联合麻醉,C组为连续硬膜外麻醉。术中观察平均动脉压、心率、血氧饱和度,记录麻醉效果和起效时间、局麻药用量及术中、术后并发症。结果3组患者在平均动脉压、心率、血氧饱和度差异无统计学意义（P〉0．05）,A组患者麻醉效果最好,满意率100％,B组次之,C组最差;起效时间,B组最快,A组次之,C组最慢,C组与A、B间有显著性差异。局麻药用量B组最少。术中、术后并发症A组有低血压4例,B组有低血压12例,恶心呕吐4例;术后头痛9例;C组低血压5例,恶心呕吐1例。三组患者均无全脊髓麻发生。结论单次硬膜外麻醉用于剖宫产手术是最好的麻醉方法。     

剖宫产术后留置导尿时间探讨

剖宫产术后一般均须留置导尿。但留置尿管不利于产妇活动,且增加了产妇感染机会,若能在可行的情况下尽早拔出导尿管,则有利于产妇休息、活动、减少和防止逆行感染及膀胱功能的恢复[1]。对60例剖宫产术后产妇进行分组对照研究。现将结果报告如下。1对象与方法1.1对象选择2005年1