scholarly journals Manajemen Anestesi untuk Seksio Sesarea pada Pasien Eklampsia dengan Perdarahan Intrakranial

2021 ◽  
Vol 10 (2) ◽  
pp. 119-126
Author(s):  
Chrismas Gideon Bangun ◽  
◽  
Sudadi Sudadi ◽  
Siti Chasnak Saleh ◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Intracranial Hemorrhage ◽  
Rapid Sequence Induction ◽  
Fetal Distress ◽  
Definitive Treatment ◽  
Increased Intracranial Pressure ◽  
Post Surgery

Intracranial haemorrhage in pregnancy is the leading cause of death in eclampsia patients. Hypertension, which is associated with both ischemic and hemorrhagic strokes, is the main feature. Definitive treatment is termination of pregnancy with cesarean section. However, it is not appropriate to start labor in an unstable mother, despite fetal distress. Once seizures can be controlled, severe hypertension is treated and hypoxia is corrected, labor may begin. The first anesthesia management goals are seizure control, blood pressure control, and prevention of increased intracranial pressure. General anesthesia is an option in the unconscious patient, or decreased consciousness with signs of increased intracranial pressure. Anesthesia is achieved with inhalation, opioids, relaxation and hyperventilation techniques carefully. In this case a 31-year-old mother, 55 kg, 36-37 weeks' gestation comes to the hospital with a decrease in consciousness and a history of seizures. Found sensorium E2M5V2, blood pressure 180/100mmHg and proteinuria 3+. Immediately, a cesarean section with general anesthesia and rapid sequence induction with fentanyl 50 mcg, propofol 100 mg and rocuronium 50 mg intravenously were performed. Post surgery the patient was treated in the ICU, head CT-Scan was performed and intracranial hemorrhage in the right temporoparietal was encountered. Management of intracranial hemorrhage was decided conservatively. The 3rd day postoperative the patient was extubated and on the 5th day the patient was transferred with E3M5V2 sensorium.

Surgical treatment of increased intracranial pressure

1926 ◽  
Vol 22 (3) ◽  
pp. 363
Author(s):  
I. Churaev
Keyword(s):  
Blood Pressure ◽  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Brain Tumors ◽  
Endocrine Glands ◽  
Cerebral Ventricles ◽  
Increased Intracranial Pressure ◽  
Normal Relationship

Disharmony in the growth of the bones of the skull and brain, which is a consequence of a violation of the correlation of the endocrine glands, brain tumors, vascular nodes on the walls of the cerebral ventricles, and finally, a violation of the normal relationship between the blood pressure of the cranial fluid - all this can serve as the cause of increased intracranial pressure.

scholarly journals Comparison between the Effects of Thiopental Sodium and Propofol on Maternal Hemodynamics during Cesarean Section Under General Anesthesia and Apgar score of the newborns

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
E Elshaer ◽  
H Omar ◽  
A Elshaer ◽  
T Youssif ◽  
W Abdelmoneim
Keyword(s):  
Blood Pressure ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Umbilical Cord ◽  
Apgar Score ◽  
Well Being ◽  
Elective Cesarean Section ◽  
Anesthetic Drugs ◽  
Significant Difference ◽  
Thiopental Sodium

Abstract Background Cesarean delivery is one of the most current surgeries in women and one of the most significant challenges of anesthesiologists in this kind of surgery is the fetuses' exposure to anesthetic drugs. Regional anesthesia is generally preferred during cesarean section, but general anesthesia may be the only option under certain circumstances such as patient preference, back deformities. The most common drugs which are used in cesarean section to induce general anesthesia are thiopental sodium and propofol. Aim compare the effect of sodium thiopental induction versus propofol induction on hemodynamics of mothers undergoing elective cesarean section under general anesthesia and their effect on Apgar score of their newborns. Materials and Methods A total 260 healthy patients were included in an open randomized study, among whom 130 patients received Thiopentone and 130 received Propofol. These patients were premedicated with granisetron and ranitidine, after induction dose the maintenance was similar for both groups. APGAR scoring and umbilical cord venous gas analysis were among the parameters used for determining the general well-being of newborns. There were no significant difference between the two groups regarding Apgar scoring in 1st, 2nd and 5th minutes. Umbilical cord blood gas values were similar . There was no metabolic acidosis in newborns of mothers receiving thiopental or propofol as anesthetic agents during cesarean section. Results Group (T) received general anesthesia with thiopental at a dose of ( 4-6 mg/kg) while patients in group (P) received general anesthesia with propofol at a dose of (2mg/kg). As regards hemodynamic changes, there were no significant difference in maternal heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure during their measurement throughout the procedure-preoperatively, after delivery of the baby,15 minutes after delivery, after extubation and in recovery room- but after intubation, there were significantly lower in propofol group which suppressed hemodynamic response to intubation . Conclusion Thiopental and propofol can be safely used in cesarean sections, but the use of propofol is more advantageous than thiopental because it provides adequate anesthetic suppression of pressor response of intubation without any depressive effect on newborns.

scholarly journals Epidural catheter migration during cesarean

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Aboud AlJa’bari
Keyword(s):  
Cesarean Section ◽  
Epidural Catheter ◽  
Cricoid Pressure ◽  
Rapid Sequence Induction ◽  
Vital Signs ◽  
Test Dose ◽  
Fetal Distress ◽  
Skin Incision ◽  
Lower Limbs ◽  
Catheter Migration

Abstract Background Early detection and vigilance of high spinal anesthesia post epidural catheter migration in cesarean section leads to safe conduct of anesthesia. Our case describes the migration of a previously functioning epidural catheter in the subarachnoid space. This migration can be explained by patient posture changes and movements. Case presentation A 32 year – old G2P0 medically free female parturient (height 160cm, weight 65 kg), admitted to the labor ward with a 4 cm cervical dilatation, an epidural catheter was inserted in the L3-4 space, and an aspiration test was negative for CSF/blood through epidural catheter. Epidural catheter was fixed on her back using sterile dressings. Epidural mixture of 0.1% bupivacaine and fentanyl 2 mcg/ml started. Due to fetal distress, cesarean section was urgently planned. She was given a bolus dose through the epidural catheter,10 minutes after skin incision, the patient suddenly started to complain of difficulty of breathing and drowsiness. Moreover, her oxygen saturation suddenly started to drop so rapid sequence induction with cricoid pressure applied and was performed till she was intubated. Her pupils were reactive and dilated. She had stable vital signs. She was reversed with neostigmine and atropine after the use of nerve stimulator. Aspiration from the epidural catheter was performed. A clear 10mls fluid was aspirated. The fluid was sent to the lab for analysis and found to be CSF. Upon extubation, the patient was conscious and obeying commands. She completely recovered the motor power of her upper and lower limbs while she was admitted to ICU for observation and she was discharged the next day without any residual anesthesia. Conclusion Aspiration test and epinephrine test dose is always recommend to be performed prior to local epidural anesthetic for cesarean section even if the function of the epidural catheter was previously established. Careful observation of neurologic signs is also important.

scholarly journals Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

2015 ◽  
Vol 133 (3) ◽  
pp. 227-234 ◽  
Author(s):  
Anıl İçel Saygı ◽  
Özkan Özdamar ◽  
İsmet Gün ◽  
Hakan Emirkadı ◽  
Ercüment Müngen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Urine Volume ◽  
Fetal Distress ◽  
Controlled Clinical Trial ◽  
Fetal Outcomes ◽  
General Anesthesia Group

CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

scholarly journals The accuracy of a clinical parameters-based scoring system to predict spontaneous intracranial hemorrhage in children under one year old

2015 ◽  
Vol 55 (3) ◽  
pp. 147
Author(s):  
Harris Alfan ◽  
Rita Dewi Arifin ◽  
Erial Bahar ◽  
Syarif Darwin Ansori
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hemorrhage ◽  
Scoring System ◽  
Roc Analysis ◽  
Receiver Operating Curve ◽  
Clinical Parameters ◽  
Increased Intracranial Pressure ◽  
History Of ◽  
Spontaneous Intracranial Hemorrhage ◽  
One Year

Background Previous studies show that most children aged less than 1 year had intracranial hemorrhage without any history of trauma. The sign and symptoms of spontaneous intracranial hemorrhage (SIH) in children varies. To minimize morbidity and mortality, early detection and accurate diagnosis are required. Head CT scans area widely used for diagnosing SIH. Unfortunately, not all health facilities in Indonesia have CT scans.Objective To determine the accuracy of a clinical parameters-based scoring system in predicting spontaneous intracranial hemorrhage (SIH) in children under one year old.Methods This diagnostic study included children aged under one year who were admitted to Mohammad Hoesin Hospital, Palembang. Patients who showed any signs of increased intracranial pressure were recruited. Data were collected from medical records from January 2007 to September 2013. Through the use of logistic regression analysis, clinical parameters showing significant relationships with computerized tomography (CT)-scan confirmed SIH were selected as predictors. Each predictor was given a score based on an adjusted ratio. The cut-off point of the total scores from all patients was determined using a receiver operating curve (ROC) analysis. The accuracy of the total scores was calculated using a 2x2 validity test.Results Of the 186 children included in this study, 98 (52.7%) had SIH and 93 (94.8%) were under 3 month-old. The predictors for SIH used included age (>3 months: score 0; 1-3 months: score 3), gender (female: score 0; male: score 1), pallor (no: score 0; yes: score 1), bulging fontanel (no: score 0; yes: score 1), pupil (isocoria: score 0; anisocoria: score 2) and history of shaken baby (no: score 0; yes: score 3). The ROC analysis showed that the area under the curve (AUC) was 95.3% with a cut-off point of 4.5, had a sensitivity of 88.7% and a specificity of 93.1%Conclusion This scoring system based on clinical parameters had good accuracy for predicting SIH in children under 1 year of age who exhibited signs of increased intracranial pressure.

scholarly journals Refractory Severe Thrombocytopenia during Pregnancy: How to Manage

2018 ◽  
Vol 40 (12) ◽  
pp. 803-807
Author(s):  
Joana Amorim ◽  
Manuel Abecasis ◽  
Filipa Rodrigues
Keyword(s):  
Platelet Count ◽  
High Risk ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Traumatic Injury ◽  
Perioperative Period ◽  
Fetal Distress ◽  
Elective Cesarean Section ◽  
Severe Thrombocytopenia ◽  
Increased Risk

AbstractThrombocytopenia is the most common hemostatic change in pregnancy, but severe thrombocytopenia is rare. One of the causes, immune thrombocytopenic purpura (ITP), is characterized by increased platelet destruction by immunoglobulin G (IgG) antibodies, presenting a high risk of hemorrhage for the patient, but also for the fetus, since antibodies may cross the placenta. We present the case of a 23-year-old pregnant woman with a history of Langerhans cell histiocytosis of the mandible submitted to surgery and chemotherapy when she was 10 years old, with diagnosis of ITP since then. At 28 weeks of gestation, she presented with petechiae, epistaxis, and gingival bleeding, with a platelet count of 3 × 109/L and positive IgG antiplatelet antibodies test. At a multidisciplinary discussion, it was decided to delay a cesarean section, due to the absence of fetal distress and to the high risk of morbidity for the patient. Many therapies were attempted without success. The IgG produced a slight and transient increase in the platelet count. On the 36th week of gestation, an elective cesarean section was performed. The perioperative period transfusions were guided by rotational thromboelastometry (ROTEM) monitoring. The procedure was performed under general anesthesia and videolaryngoscopy-assisted intubation. The patient was hemodynamically stable, without significant bleeding, and was transferred to the intensive care unit. The platelet count eventually decreased and a splenectomy was performed. Regional anesthesia may be contraindicated, and general anesthesia is associated with an increased risk of airway hemorrhage due to traumatic injury during the tracheal intubation and of hemorrhage associated with the surgical procedure. A multidisciplinary approach is essential in high-risk cases.

Rocuronium Versus Suxamethonium for Rapid Sequence Induction of General Anesthesia for Cesarean Section

2018 ◽  
Vol 38 (3) ◽  
pp. 164-165
Author(s):  
M. Kosinova ◽  
P. Stourac ◽  
M. Adamus ◽  
D. Seidlova ◽  
T. Pavlik ◽  
...  
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Rapid Sequence Induction ◽  
Rapid Sequence ◽  
Sequence Induction

scholarly journals Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Hazim Hakmi ◽  
D’Andrea K Joseph ◽  
Amir Sohail ◽  
Lee Tessler ◽  
Gerard Baltazar ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Patient ◽  
Atmospheric Pressure ◽  
Skin Flap ◽  
Neurological Status ◽  
Definitive Treatment ◽  
Trauma Patients ◽  
Increased Intracranial Pressure ◽  
Fluid Infusion ◽  
Supportive Management

Abstract Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and hyperventilation. However, after craniectomy for trauma, a partially boneless cranium may be compressed by the higher atmospheric pressure, that intracranial pressure rises to dangerous levels. For such cases, paradoxical supportive management with intravenous fluid infusion, and reverse Trendelenburg positioning, is used to counteract the higher atmospheric pressure, as a bridge to definitive treatment with cranioplasty. These steps constitute an urgent and easily applied intervention to reduce further neurological deterioration, of which every trauma healthcare provider should be aware.

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