胎盘早剥麻醉英文版资料.ppt

ACaseofPlacentalAbruptionAnesthesia Name BasicInformation Pregnantfemale27y o75kgnormalpregnancyfor38weeksMedicalhistory AfterCEAL4 5forclinicalpainlesslabourabout3hintheward theobstetricdoctorsfoundasignificantincreaseinvaginalbleedingChiefcomplaint SevereabdominalpainwithnoreliefafterCEAPasthistory Thepatientwashealthybefore Auxiliaryrecord RBT RBC3 58 1012 L WBC4 9 109 L Hb95g L PLT105 109 LCoagulationfunctiontest 3Ptest prothrombintime11secondsUltrasoundexamination anirregularliquiddarkareaofl 7cm 4 5cmbetweentheleftandthelowerpartoftheplacentaandtheuterinewall Pre evaluation ASA Mallampati Clear paleHypotention BP80 40mmHg HR120 minFHR 110 120bpmamoderateandaseverevariationofthedecelerationoccurredaboutevery20minutestoOR Anesthesia GA CEAnoeffectandhypotensionMonitoring BpECGSpO2Establishedintravenousaccess resuscitationimmediatelybyrapidinfusionofcrystalsolutionabout1000 1500mlRapidinductionintubation 100 oxygen etomidate0 2mg kg rocuronium40mg remifentanil2 g kgIntubation generallaryngoscope usedthecompressionofthecricoidpressure Anesthesia 0 5 0 8 sevoflurance untilchildbirthAfterchildbirth Propofol TCI1 2 g ml remifentanil 0 2 g kg h Sevoflurane 0 5 0 8 maintainBIS40 60 Attheendofsurgery neostigmine0 07mg kgandgranisetron3mgWhenthepatientwasfullyawake pulledouttheendotrachealtube Diagnosis 1 Placentalabruption afterthe20thweekorduringdelivery theseparationoftheplacenta innormalsite fromthesiteofuterineimplantationbeforedeliveryofthefetus2 Theearlystageofshock hypotention pale3 Fetaldistress EvaluationandAnalysis TimelyterminationofpregnancytoensurethesafetyofmotherandinfantTimelyexpansionofvolume topreventtheoccurrenceofshockandcoagulationdisordersMaintainintraoperativeBISin40 60 adjustedtheanestheticdrug sconcentrationtimelytopreventthedeepanesthesiaorintraoperativeawarenessFullyawakethenremovetheendotrachealtubetopreventaspiration Guidelines Thechoiceofanestheticdrugsshouldbeemphasizedonreducingtheimpactonthefetus sowechosethedrugsstrictlyaccordingtotheFDAguidelines mostofthemareclarifiedinBandC FDAGuidelines Inductiondrugs EtomidateCKetamineCMethohexitalBPropofolBThiopentalC Inhaledanesthetics DesfluraneBEnfluorineBHalothaneCIsofluraneCSevofluraneB FDAGuidelines Opioidclass AlfentanilCFentanylCSufentanilCPethidineBMorphineCBenzenetwonitrogen DiazepamDMidazolamD Neuromuscularblockingagents AtracuriumCCis atracuriumBOurariCMiwakuatracuriumCPancuroniumCRocurroniumBCholinechlorideCVecuroniumC Summary adequatepreparationreasonableanesthesiamethodanddrugscomprehensivemonitoringscientificregulationandcoordin