Spinalnom anestezijom inducirana hipotenzija u opstetriciji: prevencija i terapija
| Autor: | Ivan Šklebar, Tonka Bujas, Dubravko Habek |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Bradycardia hypotension 030213 general clinical medicine 0209 industrial biotechnology Nausea medicine.medical_treatment Blood Pressure Compression stockings 02 engineering and technology Anesthesia Spinal ephedrine norepinephrine 03 medical and health sciences 020901 industrial engineering & automation 0302 clinical medicine Pregnancy colloids Professional Papers Anesthesia Obstetrical Humans Medicine Caesarean section General anaesthesia Cesarean Section business.industry vasopressors spinal anaesthesia General Medicine phenylephrine crystalloids caesarean section ondansetron spinalna anestezija carski rez hipotenzija kristaloidi koloidi vazopresori efedrin fenilefrin noradrenalin Blood pressure Anesthesia Maternal Hypotension Vomiting Female medicine.symptom business |
| Zdroj: | Acta clinica Croatica Volume 58. Issue Supplement 1 Acta Clinica Croatica |
| ISSN: | 0353-9466 1333-9451 |
| DOI: | 10.20471/acc.2019.58.s1.13 |
| Popis: | Regional centro-axial anaesthesia, primarily spinal block, is the preferred method of anaesthesia for elective caesarean section because it entails fewer risks for the mother and the foetus compared to general anaesthesia. The most common side effect associated with spinal block is hypotension due to sympatholysis, occurring in up to 75% of cases. Spinal block-induced sympatholysis leads to vasodilatation and consequently causes maternal hypotension, which may compromise uterine blood flow and foetal circulation, and thus cause foetal hypoxia, bradycardia and acidosis. The selection of the most efficient treatment strategy to achieve haemodynamic stability during spinal anaesthesia for caesarean section continues to be one of the main challenges in obstetric anaesthesiology. A number of measures for the prevention and treatment of spinal block-induced hypotension are used in clinical practice, such as preloading and coloading with crystalloid and/or colloid infusion, wrapping of lower limbs with compression stockings or bandages, administering an optimal dose of local anaesthetic and achieving an optimal spinal block level, left tilt positioning, and administering inotropes and vasopressors. Instead of administering vasopressors after a drop in blood pressure has already occurred, the latest algorithms recommend a prophylactic administration of vasopressor infusion. The preferred vasoconstrictor in this case is phenylephrine, which is associated with a lower incidence of foetal acidosis, and maternal nausea and vomiting compared to other vasoconstrictors. Regionalna centroaksijalna anestezija, prvenstveno spinalni blok, danas je metoda izbora za anesteziju pri elektivnom carskom rezu jer nosi manje rizike za majku i fetus u odnosu na opću anesteziju. Najčešća komplikacija spinalnog bloka je hipotenzija koja se javlja u jedne do tri četvrtine slučajeva uslijed simpatikolize. Simpatikoliza inducirana spinalnim blokom dovodi do vazodilatacije te na taj način uzrokuje hipotenziju u majke što može kompromitirati uterini protok krvi i fetalnu cirkulaciju uzrokujući fetalnu hipoksiju, bradikardiju i acidozu. Potraga za najefikasnijom terapijskom strategijom kako bi se postigla hemodinamska stabilnost tijekom spinalne anestezije za carski rez i dalje je jedan od glavnih izazova u opstetričkoj anesteziji. U kliničkoj praksi primjenjuje se više mjera prevencije i terapije hipotenzije uzrokovane spinalnim blokom kao što je prehidracija i kohidracija infuzijom kristaloida i/ili koloida, kompresija donjih ekstremiteta elastičnim zavojima ili čarapama, optimiziranje doze lokalnog anestetika i visine spinalnog bloka, pozicioniranje s nagibom na lijevi bok te primjena inotropa i vazopresora. Umjesto primjene vazopresora nakon što nastupi pad tlaka, noviji algoritmi preporučuju profilaktičku primjenu vazopresora u infuziji pri čemu izbor pada na fenilefrin kao najčešće korišten vazokonstriktor jer se pokazalo da najmanje utječe na pojavu fetalne acidoze te mučnine i povraćanja u majke u odnosu na druge vazokonstriktore. |
| Databáze: | OpenAIRE |
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