RESUMO
Emergent attainment of uterine relaxation is an occasional need in obstetric practice. Various agents, from amyl nitrate through volatile anesthetics have been used to relax the uterus, with varying degrees of success and side-effects. Recent publications report the use of intravenous nitroglycerin (NTG), with excellent results and few adverse side effects, but preparation for injection requires time and may produce error. We have used a new sublingual aerosol spray of NTG, at an initial dose of 0.8 mg, in 7 patients for rapid uterine relaxation and have not observed adverse side-effects. Prolonged shelf life, ready availability and ease of use make the sublingual spray attractive for urgent tocolysis.
RESUMO
A prospectively designed review of all obstetric hysterectomies performed in five university hospitals between November 1, 1984 and October 31, 1987 has been performed. There were 41,107 deliveries and 46 obstetric hysterectomies, an incidence of 0.11%. Twenty-five hysterectomies were elective and 21 were emergent. The indication for 11 of the 21 emergency hysterectomies was placenta previa and/or accreta. Women in the emergency group had greater intraoperative blood loss, were more likely to have intraoperative hypotension, and were more likely to receive donor blood than women in the elective group (P less than 0.05). Twelve patients (eight from the elective group and four from the emergency group) received continuous epidural anesthesia, and none required intraoperative induction of general anesthesia. There was no evidence that epidural anesthesia significantly affected blood loss, crystalloid replacement, or requirement for transfusion in the elective group. Abnormal placentation now represents a major indication for emergency obstetric hysterectomy. Furthermore, significant hemorrhage is more likely with emergency obstetric hysterectomy than with elective hysterectomy. Finally, elective cesarean hysterectomy is not a contraindication to performance of continuous epidural anesthesia.
Assuntos
Anestesia Obstétrica , Cesárea , Histerectomia , Complicações na Gravidez/cirurgia , Adulto , Anestesia Epidural , Emergências , Feminino , Humanos , Estudos Multicêntricos como Assunto , Gravidez , Estudos ProspectivosRESUMO
The patient presenting for delivery with multiple gestation often produces extreme anxiety for those involved with her care. From the standpoint of anesthesia service, knowledge of what to expect, and better, the knowledge of what to do if and when the various potential problems present is paramount. With close communication and cooperation with the obstetrician and patient, a satisfactory anesthetic and obstetric outcome is achievable. Lumbar epidural anesthesia is highly recommended for pain management when labor and vaginal delivery is anticipated. However, the knowledgeable obstetrician and the knowledgeable anesthesiologist must be present and prepared for all circumstances.
Assuntos
Anestesia Obstétrica , Parto Obstétrico , Gravidez Múltipla , Analgésicos/uso terapêutico , Anestesia Epidural , Anestesia Geral , Cesárea , Feminino , Humanos , Trabalho de Parto , Gravidez , GêmeosRESUMO
Continuous lumbar epidural anesthesia was the primary anesthetic technique used for 25 patients having elective cesarean hysterectomy at Duke University Medical Center during a 12 1/2-year interval. Seven patients (28%) with initially satisfactory epidural anesthesia required intraoperative induction of general orotracheal anesthesia because of patient discomfort and resultant suboptimal operating conditions. Careful patient selection and preparation, expertise in administering continuous epidural anesthesia, and understanding of the demands of the operative procedure are essential when planning epidural anesthesia for cesarean hysterectomy.