Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

Başaran, Betül; Çelebioğlu, Bilge; Başaran, Ahmet; Altınel, Seher; Kutlucan, Leyla; Martin, James N.

doi:10.5152/jtgga.2016.16094

Cited by 11 publications

(16 citation statements)

References 32 publications

(37 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…During Cesarean section, hypotension following spinal anesthesia was the commonest complication related to maternal morbidity and mortality [6,8,22]. Because of inconsistent definitions, the reported incidence of hypotension after spinal anesthesia in Cesarean section varies between 7 and 89.2% [6,8,[10][11][12]. There was a widespread belief that preeclamptic parturients were considered at higher risk of profound hypotension following spinal anesthesia [12,13,22,27].…”

Section: Discussionmentioning

confidence: 99%

“…Preeclampsia with severity feature/severe preeclampsia: Defined as a systolic arterial blood pressure of 160 mmHg or higher, or a diastolic blood pressure of 110 mmHg or higher, associated with proteinuria > 5 g in 24 h [12,23]. Change in heart rate: When there was a 20% decrease or increase in heart rate from baseline [6,12,22,24,25]. The magnitude of hemodynamics change/severity of hypotension: The percentage falls of blood pressure (SBP, DBP, and MAP) between two measurements and it was calculated as [12,22,26]:…”

Section: Intraoperative Hypotensionmentioning

confidence: 99%

“…A study done in Ethiopia showed that 6.1% of indications for CS were preeclampsia [4]. There is a paradigm shift in the practice of obstetrics anesthesia from general to spinal anesthesia for Cesarean section, but the rate of preventable spinal anesthesia-related deaths is still high [5][6][7]. Hypotension after spinal anesthesia was the most frequent complication associated with maternal morbidity and mortality during Cesarean section [8].…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

et al. 2020

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Background: Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone Cesarean section under spinal anesthesia. Method: A prospective cohort study was conducted from 01 February to 28 May 2019 in preeclamptic and nonpreeclamptic parturients. We hypothesized preeclamptic parturients are at high risk of spinal anesthesia induced hypotension than non preeclamptics. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). Parturients with cardiac disease, twin pregnancy, chronic hypertension, gestational hypertension, superimposed hypertension, renal disease, diabetes mellitus, coagulopathy (platelet count < 80 × 10 9 /L), active labor, eclampsia, abruptio placentae, placenta praevia, any adjuvant added with local anesthetics were excluded. The data analysis was done using SPSS version 22 statistical software. Student t test, MannWhitney U test and Fisher exact test were used to compare the data. All P values < 0.05 were considered statistically significant. Result: The incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics. Conclusion: The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients.. Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Intraoperative Hypotensionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

et al. 2020

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“…However, spinal anesthesia-induced maternal hypotension is still the most frequent complication [20,21]. Anesthetists denied spinal anesthesia for preeclamptic parturients, due to the fear of profound hypotension and its management crisis (exaggerated response to vasopressor treatment and pulmonary edema following fluid challenges) [9,[12][13][14][15]. Furthermore, the incidence of spinal anesthesia-induced maternal hypotension showed inconsistency across different studies, which makes it almost difficult to set standard targets and develop a local management protocol [20,21,33,34].…”

Section: Introductionmentioning

confidence: 99%

Comparison of hemodynamic change following spinal anesthesia in preeclamptic and non-preeclamptic parturients undergoing cesarean section at University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

Yetneberk

Berhe

Getnet

et al. 2020

Preprint

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Background Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone cesarean section under spinal anesthesia. Method A prospective cohort study was conducted from February to May 2019 in University of Gondar comprehensive specialized hospital. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). The data analysis was done by SPSS version 22 statistical software. The data were tested for normality with Shapiro Wilk U-test and normally distributed data were compared by using the independent student’s t-test. Whereas non-normally distributed data were compared using the Mann-Whitney U- test. Fisher’s exact test was used for intergroup comparison of proportion. All P values <0.05 were considered statistically significant. Result The incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics. Conclusion The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients. Therefore, don’t deny spinal anesthesia for preeclamptic parturients due to fear of profound hypotension, unless there is a contraindication for spinal anesthesia.

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Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Peterson

Tse

Martin

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Neuraxial anesthesia can be complicated by spinal or epidural hematoma and may result in permanent neurologic injury. There is a paucity of literature characterizing this serious complication in patients with congenital and acquired hemorrhagic disorders or tendencies. The objective of this scoping review was to describe the hemostatic laboratory parameters where neuraxial anesthesia has been administered with and without spinal and epidural hematoma in patients with preexisting hemorrhagic disorders and tendencies, including immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, von Willebrand disease, coagulation factor deficiencies, and fibrinogen disorders. A systematic search of Ovid MEDLINE, CINAHL, Embase, Scopus, and Web of Science was performed. Two authors independently reviewed all titles, abstracts, and full texts to determine study eligibility and extract data. Qualitative synthesis of 91 studies revealed significant gaps in our understanding of the risk of spinal and epidural hematoma in patients with hemorrhagic disorders and tendencies, including few studies of males and in nonobstetric settings. Most reviewed articles were small, retrospective studies at high risk for potential bias. With such low‐quality data, we were unable to provide any true estimates of the risk of spinal or epidural hematoma for these patients, nor could we attribute any specific hemostatic or laboratory values to increased risk of hematoma. There is a need both for larger and more rigorously designed and reported studies on this subject and for structured, comprehensive recommendations for safe administration and removal of neuraxial anesthesia in patients with hemorrhagic disorders and tendencies.

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Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

Cited by 11 publications

References 32 publications

Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

Comparison of hemodynamic change following spinal anesthesia in preeclamptic and non-preeclamptic parturients undergoing cesarean section at University of Gondar comprehensive specialized hospital, Northwest Ethiopia.

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

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