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Titolo:
Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: A preliminary report
Autore:
Ramanathan, J; Vaddadi, AK; Arheart, KL;
Indirizzi:
Univ Tennessee, Dept Anesthesiol, Memphis, TN 38103 USA Univ Tennessee Memphis TN USA 38103 pt Anesthesiol, Memphis, TN 38103 USA Univ Tennessee, Dept Obstet & Gynecol, Memphis, TN 38103 USA Univ Tennessee Memphis TN USA 38103 stet & Gynecol, Memphis, TN 38103 USA Univ Tennessee, Dept Prevent Med, Memphis, TN 38103 USA Univ Tennessee Memphis TN USA 38103 pt Prevent Med, Memphis, TN 38103 USA Univ Tennessee, Dept Biostat, Memphis, TN 38103 USA Univ Tennessee Memphis TN USA 38103 , Dept Biostat, Memphis, TN 38103 USA
Titolo Testata:
REGIONAL ANESTHESIA AND PAIN MEDICINE
fascicolo: 1, volume: 26, anno: 2001,
pagine: 46 - 51
SICI:
1098-7339(200101/02)26:1<46:CSAEAW>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
CESAREAN-SECTION; PREGNANCIES; HYPOTENSION; MORPHINE;
Keywords:
severe preeclampsia; combined spinal and epidural anesthesia;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
21
Recensione:
Indirizzi per estratti:
Indirizzo: Ramanathan, J Univ Tennessee, Dept Anesthesiol, 877 Jefferson Ave,6th Floor,Chandler Bldg, Memphis, TN 38103 USA Univ Tennessee 877 Jefferson Ave,6thFloor,Chandler Bldg Memphis TN USA 38103
Citazione:
J. Ramanathan et al., "Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: A preliminary report", REG ANES PA, 26(1), 2001, pp. 46-51

Abstract

Background and Objectives: The purpose of our study was to evaluate the quality of anesthesia for cesarean delivery (CD), analgesia for labor (LA), hemodynamic changes, and neonatal effects of combined spinal and epidural anesthesia (CSE) with tow intrathecal doses of bupivacaine and fentanyl in patients with severe preeclampsia. Methods: Of the 85 patients with severe preeclampsia (systolic pressures [SBP] greater than or equal to 160 mm Hg or diastolic pressures [DBP] greater than or equal to 110 mm Hg, and proteinuria greater than or equal to 100 mg/dL), 46 underwent CD and 39 delivered vaginally. The CD group received 7.5 mg of hyperbaric bupivacaine and 25 mug fentanyl intrathecally with a goal of obtaining a T4 sensory block. Those with levels less than T4 received2% lidocaine epidurally to extend the block. Ln the LA group, the intrathecal dose was 1.25 mg of plain bupivacaine with 25 mug of fentanyl, followedby epidural infusion of 0.0625% to 0.125% bupivacaine with 2 to 4 mug fentanyl/ml at 12 to 15 mL/h. Results: In the CD group, all but 4 patients had greater than or equal to T4 block, and these 4 patients received 2% lidocaine epidurally. None required conversion to general anesthesia. In the LA group, sensory levels were TIO (range, T6-L2) with adequate analgesia. The baseline mean arterial pressure (MAP) was 122 +/- 13 mm Hg in the CD group and 117 +/- 12 mm Hg in theLA group. After CSE, MAP decreased significantly and reached a nadir within 5 minutes in both groups (103 +/- IZ mm Kg in the CD group and 96 +/- 13 mm Hg in the LA group, P < .05). The maximum decrease in MAP was similar inthe 2 groups (-15% +/- 8% in the CD group and -16% +/- 9% in the LA group). The neonatal Apgar scores and umbilical artery (UA) pH were similar, and there were no significant correlations between UA pH and lowest MAP before delivery or the maximum percentage change in MAP in either group. Conclusions: The results indicate that CSE with low intrathecal doses of bupivacaine and epidural supplementation, when needed, produces adequate anesthesia for CD and analgesia for labor in patients with severe preeclampsia. The maximum decreases in MAP after CSE were modest and quite similar in the 2 groups.

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Documento generato il 06/04/20 alle ore 01:53:29