胎盘早剥麻醉英文版资料 .ppt

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1、A Case of Placental Abruption Anesthesia Name Basic InformationPregnant female 27y/o 75kg normal pregnancy for 38 weeksMedical history:After CEA L4-5 for clinical painless labour about 3 h in the ward,the obstetric doctors found a significant increase in vaginal bleedingChief complaint:Severe abdomi

2、nal pain with no relief after CEAPast history:The patient was healthy beforeAuxiliary recordRBT:RBC 3.58*1012/L,WBC 4.9*109/L,Hb 95g/L,PLT 105*109/LCoagulation function test,3P test(-)prothrombin time 11 seconds Ultrasound examination:an irregular liquid dark area of l.7cm*4.5cm between the left and

3、 the lower part of the placenta and the uterine wallPre-evaluationASA:Mallampati:Clear,paleHypotention:BP 80/40 mmHg,HR 120 /minFHR:110-120 bpma moderate and a severe variation of the deceleration occurred about every 20 minutesto OR Anesthesia GA:CEA no effect and hypotension Monitoring:Bp ECG SpO2

4、Established intravenous access,resuscitation immediately by rapid infusion of crystal solution about 1000-1500 mlRapid induction intubation:100%oxygen+etomidate 0.2 mg/kg+rocuronium 40mg+remifentanil 2 g/kgIntubation:general laryngoscope,used the compression of the cricoid pressureAnesthesia 0.5%0.8

5、%sevoflurance,until childbirthAfter childbirth:Propofol(TCI 1-2g/ml+remifentanil(0.2g/kgh)+Sevoflurane(0.5-0.8%)maintain BIS 40-60.At the end of surgery,neostigmine 0.07 mg/kg and granisetron 3mg When the patient was fully awake,pulled out the endotracheal tubeDiagnosis 1.Placental abruption:(after

6、the 20th week or during delivery)the separation of the placenta(in normal site)from the site of uterine implantation before delivery of the fetus2.The early stage of shock:hypotention,pale3.Fetal distressEvaluation and Analysis1.Timely termination of pregnancy to ensure the safety of mother and infa

7、nt2.Timely expansion of volume,to prevent the occurrence of shock and coagulation disorders3.Maintain intraoperative BIS in 40-60,adjusted the anesthetic drugs concentration timely to prevent the deep anesthesia or intraoperative awareness 4.Fully awake then remove the endotracheal tube to prevent a

8、spiration Guidelines The choice of anesthetic drugs should be emphasized on reducing the impact on the fetus,so we chose the drugs strictly according to the FDA guidelines,most of them are clarified in B and C FDA Guidelines Induction drugs:Etomidate C Ketamine C Methohexital B Propofol B Thiopental

9、 C Inhaled anesthetics:Desflurane B Enfluorine B Halothane C Isoflurane C Sevoflurane B FDA Guidelines Opioid class:Alfentanil C Fentanyl C Sufentanil C Pethidine B Morphine C Benzene two nitrogen:Diazepam D Midazolam DNeuromuscular blocking agents:Atracurium CCis-atracurium B Ourari C Miwaku atracu

10、rium C Pancuronium C Rocurronium B Choline chloride C Vecuronium C Summaryadequate preparation reasonable anesthesia method and drugscomprehensive monitoring scientific regulation and coordination the safety of mother and childpromoted the success of cesarean sectionensureThangk you very much!My report is over.Welcome your valuable opinions!