Perioperative Management of Patients with Preeclampsia: A Comprehensive Review.

IF 9.1 1区医学 Q1 ANESTHESIOLOGY Anesthesiology Pub Date : 2025-02-01 Epub Date: 2025-01-14 DOI:10.1097/ALN.0000000000005296

Alicia T Dennis, Annie Xin, Michaela K Farber

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Abstract

Preeclampsia is a common condition of pregnancy characterized by hypertension complicated by cerebral, cardiac, hepatic, renal, hematologic, and placental dysfunction. Patients with preeclampsia frequently undergo cesarean delivery, the most common major surgical procedure in the world. They represent a high-risk perioperative cohort suffering significant preventable morbidity and mortality. This review focuses on the anesthesiologist's role, through a perioperative lens, in reducing maternal complications through management of hypertension and strategies for preserving the function of the brain, heart, liver, kidney, hematologic and coagulation systems, and placenta in patients with preeclampsia undergoing cesarean delivery. Preeclampsia-specific resuscitation, individualized fluid administration, safe neuraxial and general anesthesia, and management of intraoperative bleeding are discussed along with strategies for postoperative analgesia, thromboprophylaxis, and antihypertensive agents in patients who breastfeed. This review discusses recently recognized postoperative deterioration in maternal mental health, the possibility of myocardial injury after cesarean delivery, and the need for long-term cardiometabolic follow-up.

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子痫前期患者围手术期的处理：一项综合综述。

子痫前期是一种常见的妊娠状况，其特征是高血压并发脑、心、肝、肾、血液学和胎盘功能障碍。先兆子痫患者经常接受剖宫产，这是世界上最常见的主要外科手术。他们是高危围手术期人群，可预防的发病率和死亡率很高。这篇综述的重点是麻醉师的作用，通过围手术期的镜头，在减少产妇并发症，通过管理高血压和策略，以保持脑、心、肝、肾、血液和凝血系统，以及胎盘的功能先兆子痫剖宫产患者。本文讨论了先兆子痫特异性复苏、个体化液体给药、安全的神经轴和全身麻醉以及术中出血的处理，以及母乳喂养患者术后镇痛、血栓预防和降压药的策略。这篇综述讨论了最近公认的剖宫产术后产妇心理健康的恶化、剖宫产后心肌损伤的可能性以及长期心脏代谢随访的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anesthesiology 医学-麻醉学

CiteScore

10.40

自引率

5.70%

发文量

542

审稿时长

3-6 weeks

期刊介绍： With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.