RESUMO
Background The presence ofpulmonary arterial hypertension (PAH) in pregnant women increases mortality up to 12- 30% and up to 50% when PAH is associated with Eisenmenger syndrome. Due to low prevalence of PAH in pregnancy many aspects ofperioperative management are still unclear. THE AIM: To summarize our approaches to the anesthesia and intensive care in pregnant women with PAH. MATERIALS AND METHODS: 21 pregnant women with PAH (systolic pulmonary artery pressure (SPAP) higher than 60 mm Hg)-who underwent delivery by Caesarean section in 2010 - 2015 were included in the one-centre retrospective study. Data are presented as median (25th, 75th percentile). RESULTS: The median age was 27 (23; 29) years. Among the patients, there were 4 (19%) cases of idiopathic PAH and in 17 (81%) women PAH was associated with congenital heart disease (CHD); 12 (57%) patients'demonstrated Eisenmenger syndrome. Baseline SPAP was 90 (82; 103) mm Hg. SpO2 90 (85,95)%. All women taken PAH-specific therapy (sildenafil) before delivery. Caesarean section (CS) were performed at 32 (28; 34) weeks. In 20 cases CS was perfofined under epidural anesthesia and in one case under general anesthesia due thrombocytopenia. Inhaled nitric oxide (NO) was administered intraoperative to all women in a dose of 40-60 ppm. Postoperative period was uncomplicated in five women (23?8%). Decompensation with PAP rise, acute right ventricular failure and hypoxemia developed in 16 (76,2%) cases 30 (24, 40) h after abdominal delivery. These patients required combined PAH-specific therapy (NO, sldenafil, iloprost) and inotropic agents, additionallyrespiratory support was used in four patients. The median ICU stay was 13 (9; 22) days. 3 patients died (14?2%); mortality in Eisenmenger syndrome cases was 25% (3/12). 18 healthy babies.
Assuntos
Anestesia por Inalação/métodos , Cesárea , Cuidados Críticos/métodos , Hipertensão Pulmonar/cirurgia , Complicações na Gravidez/cirurgia , Adulto , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/mortalidade , Monitorização Intraoperatória , Período Perioperatório , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez , Respiração Artificial , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Tireoidite Subaguda , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Diagnóstico Diferencial , Humanos , Padrões de Prática Médica , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/tratamento farmacológico , Tireoidite Subaguda/etiologiaAssuntos
Amnésia/etiologia , Campos Eletromagnéticos/efeitos adversos , Animais , Masculino , Ratos , Ratos Wistar , Fatores de TempoRESUMO
Low-intensity electromagnetic field (12.6 cm, 2375 MHz, power density 1 mW/cm2) produced retrograde amnesia in the rat passive avoidance test. No effect was registered of microwave irradiation on the open field behavior and the pain sensitivity. Functional activity of the m-cholinergic receptors decreased, but their number increased in the brain cortex. It is suggested that cholinergic system plays an important role in the effects of electromagnetic field on memory processes.