Ebook Obstetric anesthesia for co-morbid conditions: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Obstetric anesthesia for co-morbid conditions: Part 2
Ebook Obstetric anesthesia for co-morbid conditions: Part 2
Check for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 .1General ConsiderationsNeurological diseases affecting pregnant patients can be classified into three main groups:1Pre-existing chronic neurological diseases such as epilepsy and multiple sclerosis2Disorders with onset predominantly during pregnancy such as cerebrovascular events3Neurological condi Ebook Obstetric anesthesia for co-morbid conditions: Part 2 tions which are specifically related to pregnancy such as eclampsiaThis chapter focuses exclusively on the common pre-existing neurological comorbiditEbook Obstetric anesthesia for co-morbid conditions: Part 2
ies affecting obstetric patients and their anesthetic implications. Neurological disorders account for a significant cause of maternal morbidity and mCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 ical disorders represented the second most frequent cause of indirect maternal deaths in the UK 11 J. As a result of the improvements in the therapeutic options for many neurological conditions over the past few decades, significant number of women with these disorders manages to become pregnant. In Ebook Obstetric anesthesia for co-morbid conditions: Part 2 addition, more information is now available to help clinicians guide patients on which treatments need to be continued and how they should be adminisEbook Obstetric anesthesia for co-morbid conditions: Part 2
tered.D. DabrowskaChelsea and Westminster Hospital NHS Foundation Trust. London. UK€> Springer International Publishing AG. part of springer Nature 20Check for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 with neurological disease who is pregnant or wishes to become pregnant should have a pre-pregnancy or early antenatal consultation with the obstetrician, neurologist, and obstetric anesthetist. The aim would be to assess the severity of the disease, review current medications, and advise the patient Ebook Obstetric anesthesia for co-morbid conditions: Part 2 about any possible teratogenic effects. Neurological assessment should be performed during this consultation, and appropriate investigations, includiEbook Obstetric anesthesia for co-morbid conditions: Part 2
ng neuroimaging and neurophysiological testing, should be arranged. Any pre-existing neurological deficit should be meticulously documented in view ofCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 f neurological complications for patients w ith preexisting disease can increase even further.Anesthetic management of obstetric patients with neurological comorbidities can be challenging. Regional analgesia and anesthesia techniques offer many clinical benefits in the obstetric population but may Ebook Obstetric anesthesia for co-morbid conditions: Part 2 be contraindicated in the presence of raised intracranial pressure, tethered spinal cord, or unstable disease. Moreover, abnormal anatomy such as kyphEbook Obstetric anesthesia for co-morbid conditions: Part 2
oscoliosis can make the insertion of epidural or spinal needle technically difficult or even impossible. The dose of the local anesthetic needs to be Check for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 neral anesthesia needs to be administered, this may carry significant risk due to associated rises in systolic blood pressure and its adverse effect on intracranial pressure. Therefore, rapid sequence induction should be modified by the addition of a shortacting opioid, such as remifentanil, in orde Ebook Obstetric anesthesia for co-morbid conditions: Part 2 r to obtund the hypertensive response to laryngoscopy. In many neurological conditions, such as multiple sclerosis, increased sensitivity to depolarizEbook Obstetric anesthesia for co-morbid conditions: Part 2
ing muscle relaxants is present. Succinylcholine may also cause hyperkalemia and cardiac arrest in those patients. In view' of this, and the widespreaCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 such as isoflurane or sevoflurane are appropriate for the maintenance of anesthesia in view of their positive effect on preservation of the cerebral perfusion pressure and cerebral oxygen consumption.Anesthetic complications which may occur during and after delivery, such as post-dural puncture head Ebook Obstetric anesthesia for co-morbid conditions: Part 2 ache or new-onset neurological deficit, can be difficult to distinguish from those related to the negative effects of pregnancy on the disease itself.Ebook Obstetric anesthesia for co-morbid conditions: Part 2
A high index of suspicion should be present whenever new' neurological symptoms are identified during the postnatal follow-up visit in order for apprCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 ressive neurological disease affecting the central nervous system, which causes a w ide range of symptoms such as fatigue, visual disturbance, muscle weakness, sensory loss in the limbs, as well as bowel and8 Anesthetic Management of Pregnant Patient with Neurological119bladder dysfunction. Its unde Ebook Obstetric anesthesia for co-morbid conditions: Part 2 rlying mechanism is a demyelination of the nerve fibers with axonal damage and loss of myelin sheath causing disruption in conduction of the electricaEbook Obstetric anesthesia for co-morbid conditions: Part 2
l impulse to and from the brain. The incidence of the disease is 3.6 cases per 100.000. and it is estimated that 2.5 million people in the world are aCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 to be affected compared to men, and the diagnosis is frequently made during the second and third decades of their lives. Patients with MS are frequently treated with disease-modifying drugs (DMDs) such as interferon and/or glatiramer. Current advice is to stop treatment if they are planning to beco Ebook Obstetric anesthesia for co-morbid conditions: Part 2 me pregnant due to limited data available to support safety of these agents in pregnancy. Symptoms of progressive disease such as spasticity, bladderEbook Obstetric anesthesia for co-morbid conditions: Part 2
dysfunction, and depression are treated with baclofen, intermittent catheterization, and antidepressants.Pregnancy itself has a protective effect on tCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 ospective study of MS in pregnant women (PRIMS study) has demonstrated that the risk of relapses is significantly higher in the immediate postpartum period and all pregnant patients affected by MS should be adequately informed about this effect [2]. Multiple sclerosis does not have a negative impact Ebook Obstetric anesthesia for co-morbid conditions: Part 2 on the course of the pregnancy, and therefore obstetric and neonatal outcomes do not differ between patients with MS and the general population.The aEbook Obstetric anesthesia for co-morbid conditions: Part 2
nesthetic management of the pregnant patient with multiple sclerosis has been a subject of controversy in the past. Some studies reported an increasedCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 increased frequency of the relapses in the immediate postdelivery period, this relationship can be purely casual. There is also some indirect evidence suggesting that epidural technique is of less risk compared to spinal block, probably in view of limited amount of local anesthetic getting in contac Ebook Obstetric anesthesia for co-morbid conditions: Part 2 t with cerebrospinal fluid.However, these findings are based on experimental rather than clinical studies [4]. In the last decade, there have been sevEbook Obstetric anesthesia for co-morbid conditions: Part 2
eral case reports in the literature reporting safe administration of spinal and epidural techniques for labor and delivery in patients with MS. A survCheck for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 . Nevertheless, the demyelinated neurons are more susceptible to develop exaggerated block response and local anesthetic toxicity, and therefore lower concentrations of local anesthetics should be administered. Data describing use of regional and general anesthesia for cesarean section in parturient Ebook Obstetric anesthesia for co-morbid conditions: Part 2 s w ith multiple sclerosis is limited; however, current opinion considers both of them to be safe. Pastóet al. [6] investigated 423 pregnancies in 415Ebook Obstetric anesthesia for co-morbid conditions: Part 2
patients with multiple sclerosis. Cesarean section was performed in 155 patients, out of which 46 under regional anesthesia. No association has been Check for uptMeeAnesthetic Management of Pregnant Patient with Neurological and Neuromuscular DisordersDominika Dabrowska8.1Neurological Disorders8.1. Ebook Obstetric anesthesia for co-morbid conditions: Part 2 DabrowskaIf general anesthesia is necessary due to patient’s preferences or the surgical urgency, special attention needs to be emphasized on temperature control and the use of the muscle relaxants. Demyelinated nerves arc very sensitive to increase in body temperature, which can translate into exa Ebook Obstetric anesthesia for co-morbid conditions: Part 2 cerbation of the symptoms, and therefore excessive wanning should be avoided. Suceinylcholine can produce severe hyperkalemia especially in patients wEbook Obstetric anesthesia for co-morbid conditions: Part 2
ith advanced disease and limb spasticity due to upregulation of the acetylcholine receptors, and this agent should be used with caution or avoided. PaGọi ngay
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