Anesthetic Management for Obstetric Hysterectomy

Chestnut, D.H.; Dewan, David M.; Redick, Lloyd F.; Caton, Donald; Spielman, Frederick John

doi:10.1097/00132582-198910000-00003

Cited by 10 publications

(13 citation statements)

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“…[1][2][3][4] Peripartum hysterectomy has been performed successfully under general as well as regional anesthesia. 1 However, intraoperative general anesthesia may be required occasionally during the procedures performed under regional anesthesia when associated with prolonged surgery, patient discomfort, or hemodynamic instability. 2 We evaluated airway changes in a patient scheduled for elective Cesarean hysterectomy to document changes in the airway that could predispose to a subsequent difficult intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Discussion Peripartum hysterectomy is often associated with substantial blood loss and fluid requirement (2-8 L fluid and 1-15 units blood, occasionally up to 28 L of fluid and 56 units of blood products.). [1][2][3][4] Airways in pregnant patients are susceptible for developing tissue edema as a result of intravenous infusion of fluids that produce a decrease in the colloid osmotic pressure which is already decreased in pregnant subjects. 5,6 Our patient received 6 L crystalloid, 1 L colloid, and 5 units packed RBCs and the airway changed from class 2 to class 4 at the conclusion of surgery.…”

Section: Discussionmentioning

confidence: 99%

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Airway changes during cesarean hysterectomy

Bhavani-Shankar

Lynch

Datta

2000

Can J Anesth/J Can Anesth

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Purpose: To document whether hemorrhage and fluid administration during peripartum hysterectomy results in changes in the airway that may predispose to subsequent difficult intubation, in the event that intraoperative general anesthesia is required during regional anesthesia.Clinical features: A 32-yr-old underwent peripartum hysterectomy for placenta accreta. Blood loss of 5.5 L occurred during surgery requiring 6 L crystalloid, 1 L hetastarch, five units packed RBCs and two units fresh frozen plasma. Airway changes were followed using Samsoon's modification of Mallampati airway classification. In addition, airway photographs were obtained using a Polaroid camera. The airway of the patient changed from class 2 preoperatively to class 4 in the immediate postoperative period. The airway gradually returned to normal over the ensuing 48 hr, during which a negative fluid balance of 4 L occurred due to substantial postoperative diuresis.Conclusion: Peripartum airway changes were detected during Cesarean hysterectomy and fluid resuscitation that gradually returned to normal within 48 hr after surgery.Objectif : Vérifier si une hémorragie et l'administration de liquide pendant une hystérectomie péripartum peut modifier l'intubation prédisposant à une intubation difficile subséquente, dans le cas où une anesthésie générale peropératoire serait nécessaire pendant l'anesthésie régionale.Éléments cliniques : Une femme de 32 ans a subi une hystérectomie péripartum à cause d'un placenta accreta. Une perte sanguine de 5,5 L est survenue pendant l'opération et a nécessité 6 L de cristalloïde, 1 L de hetastarch, cinq culots globulaires et deux unités de plasma frais congelé. Les changements de l'intubation ont été observés grâce à la modification de Samsoon de la classification de Mallampati. De plus, des photographies de l'intubation ont été réalisées avec une caméra Polaroïd. L'intubation du patient est passée de la classe 2, avant l'opéra-tion, à la classe 4, immédiatement après. Elle est graduellement revenue à la normale au cours des 48 h qui ont suivi et durant lesquelles un bilan hydrique négatif de 4 L est survenu, causé par une importante diurèse postopératoire.Conclusion : Les changements dans l'intubation péripartum ont été détectés pendant l'hystérectomie postcésari-enne et la réanimation liquidienne qui se sont graduellement normalisés pendant les 48 h qui ont suivi l'intervention chirurgicale.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Airway changes during cesarean hysterectomy

Bhavani-Shankar

Lynch

Datta

2000

Can J Anesth/J Can Anesth

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“…However, a multicenter study demonstrated that blood loss was not excessive during elective caesarean hysterectomy under regional anaesthesia and therefore did not contraindicate its use. 15 If consideration is given to regional anaesthesia for elective Caesarean hysterectomy there are four possible techniques. Single-shot subarachnoid blockade provides excellent anaesthesia but has the disadvantage of a finite duration.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for Caesarean hysterectomy in a patient with a preoperative diagnosis of placenta percreta with invasion of the urinary bladder

et al. 1996

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“…Placenta previa, is a major cause of massive hemorrhage and can result in maternal or fetal morbidity and mortality [1,2]. Its incidence is 4.8 per 1000 deliveries with a mortality rate of 0.03% [3].…”

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confidence: 99%

Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

et al. 2014

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Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P < 0.05 was considered significant. Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P < 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate >125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P < 0.001. Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.

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Anesthetic Management for Obstetric Hysterectomy

Cited by 10 publications

References 0 publications

Airway changes during cesarean hysterectomy

Airway changes during cesarean hysterectomy

Anaesthesia for Caesarean hysterectomy in a patient with a preoperative diagnosis of placenta percreta with invasion of the urinary bladder

Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

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