22 feb. 2011 WHAT ANESTHESIA WE CHOOSE FOR CESAREAN SECTION IN SEVERE PREECLAMPTIC PARTURIENTS
C. Milea*, S. Surugiu**, F. Stamatian**
* Spitalul Clinic Judeţean de Urgenţă Cluj-Napoca
** Catedra de Obstetrică-Ginecologie I, Universitatea de Medicină şi Farmacie “Iuliu Haţieganu”, Cluj-Napoca.
Rezumat
In stadiul actual al cunoasterii medicina se practica bazata pe dovezi. Astfel, desi, foarte apreciata la pacientele obstetricale fara patologie asociata anestezia neuraxiala in cazul pacientelor preeclamptice are nevoie de dovezi pentru a-i sustine lipsa complicatiilor materno – fetale, a beneficiilor vis-ŕ-vis de tehnicile de anestezie generala. In studiul nostru am inrolat parturiente cu preeclampsia severa care dupa consimtire si randomizare au beneficiat pe durata sectiunii cezariene de una din tehnicile de anestezie regionala: rahianestezie sau peridurala; sau de anestezie generala. Am condus acest studio din perspective afectarii mortalitatii si morbiditatii asociata cu tehnica anestezica folosita. Astfel, desi, incidenta hipotensiuni arteriale este mai crescuta la pacientele cu anestezie neuraxiala, aceasta este de scurta durata si usor tratata fara a avea impact asupra statusului fiziologic al nou nascutului. In urma rezultatelor obtinute sustinem alegerea anesteziei neuraxiale, a rahianesteziei cand nu este déjŕ un cateter peridural inserat, in defavoarea anesteziei generale.
Abstract – What Anesthesia we choose for cesarean section in severe preeclamptic parturients
In our days when medicine is heavily depending on evidences, the choice of neuraxial anesthesia in obstetric patients with no associated illness is easily taken. But, for severely preeclamptic parturients the use of neuraxial anesthesia needs to be sustained by evidence against materno-fetal complications and general anesthesia. Our study was designed in the view of any possible complications that may appear during or after anesthesia. So, we choose the variables that monitor the wellbeing of the parturient and of the neonate. After the obtained results we can conclude that even the incidence of hypotension is higher in neuraxial technique, this is easily treated and short lived with no consequences on the neonate mortality or morbity. Based on our results and other previous studies we sustain the use of neuraxial anesthesia(spinal when no epidural catheter already present) against the general anesthesia.
Keywords: anesthesia, cesarean section, preclampsia