Solo Journal of Anesthesi, Pain and Critical Care (SOJA)最新文献

A Meta-Analysis of 80% Fraction of Inspired Oxygen on Surgical Site Infection in Patients Undergoing Surgery 80%吸氧率对手术患者手术部位感染的meta分析

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2023-04-30 DOI: 10.20961/soja.v3i1.62251

Rifaldy Nabiel Erisadana, A. Tohari, Yehuda Tri Nugroho Supranoto, W. S. Utami, Laksmi Indreswari

Background: WHO recommended the use of 80% FiO2 in patients undergoing general anesthesia with endotracheal intubation (ETI) to prevent surgical site infection (SSI). However, the ongoing debate regarding efficacy and safety raises because further trials have been published. We conducted a review based on recommendations in terms of SSI as the primary outcome and adverse events as the secondary outcome in both patients with or without ETI.Method: A literature search was carried out by PubMed, ScienceDirect, and Google Scholar for RCTs in all-type surgical patients who administrated 80% FiO2 compared with 30–35% FiO2. Pooled relative risks with a 95% confidence interval were conducted for meta-analysis. Result: Based on 23 RCTs included in the analysis, there were no significant differences in terms of SSI (RR,0.85; 95%CI, 0.72 to 1.01; p=0.07), sepsis (RR,1.47; 95%CI, 0.78 to 2.76; p=0.23), postoperative hospitalization days (PHD) (RR,0.16; 95%CI, -0.67 to 0.98; p=0.71), ICU admission (RR,0.94; 95%CI, 0.78 to 1.13; p=0.50), reoperation required (RR,0.78; 95%CI, 0.30 to 2.06; p=0.62), and 30-days mortality (RR,1.18; 95%CI, 0.76 to 1.84; p=0.45). In contrast, even though the subgroup analysis showed association that PHD longer in high FiO2 group for colorectal surgery (RR,0.80; 95%CI, 0.24 to 1.35; p=0.005), the high FiO2 significantly reduced SSI and anastomotic leakage in abdominal surgery (RR,0.78; 95%CI, 0.62 to 0.99; p=0.04 and RR,0.55; 95%CI, 0.36 to 0.85; p=0.008).Conclusion: This meta-analysis provides evidence that administration of 80% FiO2 even though association with longer of PHD in colorectal surgery, it is associated with a reduction in SSI and anastomotic leakage in patients who underwent abdominal surgery. It contrasts for sepsis, ICU admission, reoperation required, 30-day mortality, SSI, and PHD in all-type surgery.

背景:世卫组织推荐气管插管(ETI)全麻患者使用80% FiO2以预防手术部位感染(SSI)。然而，由于进一步的试验已经发表，关于有效性和安全性的争论正在增加。我们根据建议进行了一项综述，将SSI作为主要结局，不良事件作为次要结局，在有或没有ETI的患者中。方法:通过PubMed、ScienceDirect和Google Scholar检索所有类型手术患者的随机对照试验(rct)，比较FiO2浓度为80%和30-35%的患者。采用95%置信区间的综合相对危险度进行meta分析。结果:在纳入分析的23项rct中，两组间SSI无显著性差异(RR,0.85;95%CI, 0.72 ~ 1.01;p=0.07)，脓毒症(RR,1.47;95%CI, 0.78 ~ 2.76;p=0.23)、术后住院天数(PHD) (RR,0.16;95%CI， -0.67 ~ 0.98;p=0.71)， ICU住院(RR,0.94;95%CI, 0.78 ~ 1.13;p=0.50)，需要再次手术(RR,0.78;95%CI, 0.30 ~ 2.06;p=0.62)， 30天死亡率(RR,1.18;95%CI, 0.76 ~ 1.84;p = 0.45)。相比之下，尽管亚组分析显示，高FiO2组的PHD较长与结直肠手术相关(RR,0.80;95%CI, 0.24 ~ 1.35;p=0.005)，高FiO2显著降低腹部手术SSI和吻合口漏(RR,0.78;95%CI, 0.62 ~ 0.99;p=0.04, RR = 0.55;95%CI, 0.36 ~ 0.85;p = 0.008)。结论:本荟萃分析提供的证据表明，在结肠直肠手术中给予80% FiO2虽然与更长时间的PHD有关，但它与腹部手术患者SSI和吻合口漏的减少有关。它对比了所有类型手术的脓毒症、ICU入院、再手术要求、30天死亡率、SSI和PHD。

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引用次数: 0

Permissive Hypotension Strategy in Open-surgery of Abdominal Aortic Aneurysm 腹主动脉瘤开腹手术中的降压策略

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2023-04-30 DOI: 10.20961/soja.v3i1.62208

Alvian Chandra Budiman, Handayu Ganitafuri, B. Putro

Background: Open-surgery in patients with aortic aneurysms has always been a challenge for every anesthesiologist. The risk of massive bleeding, hemodynamic instability, and peripheral perfusion insufficiency are some of the reasons for the need of appropriate perioperative management. The purpose of this case report is to describe the permissive hypotension strategy in open-surgery of abdominal aortic aneurysm. Case Ilustration: A 65-year-old man with radiologic findings of an aneurysm in the abdominal aorta at 3rd-4th lumbar vertebrae level was planned for open-surgery aneurysmectomy and aortic graft. Pre-operative assessment concluded the physical status of ASA III. Patient was planned to receive general anesthesia. Invasive hemodynamic monitoring was performed by placing an arterial line and a central venous catheter. Just before the aortic clamp procedure, permissive hypotension strategy was started by lowering systolic blood pressure using titrated doses of nitroglycerin with target MAP of >60 mmHg. Bleeding management was carried out with intravascular fluid resuscitation until the CVP target of 7-8 mmHg was achieved. When the aortic clamp was released, titrated dose of norepinephrine was administered with target MAP of 65-75 mmHg. Post-operatively, the patient was admitted to the ICU. The patient was discharged on the seventh post-operative day. Conclusion: This case demonstrated the successful perioperative management of an open surgery aneurysmectomy by maintaining the hemodynamic stability of the patient using permissive hypotension strategy. The successful stabilization of patient’s hemodynamic state during surgery resulted in a good and fast post-operative outcome and recovery.

背景:主动脉瘤患者的开腹手术一直是每个麻醉师面临的挑战。大出血、血流动力学不稳定和周围灌注不足的风险是需要适当围手术期管理的一些原因。本病例报告的目的是描述腹主动脉瘤开腹手术中的容许性低血压策略。病例说明:65岁男性，放射学发现腹主动脉动脉瘤位于第3 -4腰椎水平，计划行开腹手术切除动脉瘤并主动脉移植。术前评估得出ASA III的身体状况。病人计划接受全身麻醉。通过放置动脉导管和中心静脉导管进行有创血流动力学监测。在主动脉夹钳手术之前，开始了容许性降压策略，使用滴定剂量的硝酸甘油降低收缩压，目标MAP为bb60 mmHg。出血处理采用血管内液体复苏，直到CVP达到7-8 mmHg的目标。释放主动脉钳后，滴注去甲肾上腺素，目标MAP为65 ~ 75 mmHg。术后，患者住进ICU。患者于术后第7天出院。结论:本病例通过采用容许性低血压策略维持患者血流动力学稳定，成功地完成了开放性动脉瘤切除术的围手术期治疗。手术过程中患者血流动力学状态的成功稳定导致了良好和快速的术后结果和恢复。

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引用次数: 0

Outcome Comparison Between Insulin-Dependent and Non Insulin-Dependent Patients after Open Adult Cardiac Surgery 成人心脏直视手术后胰岛素依赖与非胰岛素依赖患者的结局比较

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2023-04-30 DOI: 10.20961/soja.v3i1.66306

J. Kurniawaty, B. Setianto, S. Supomo, Y. Widyastuti, Cornelia Ancilla, C. E. Boom

Background: Insulin-dependent diabetic patients usually have poor glycemic control and higher risk of complications than non-insulin-dependent diabetic patients. However, the difference in clinical outcomes between these two groups of patients who underwent open cardiac surgery was not established. Therefore, this study compares the short-term outcome of insulin vs non-insulin-dependent diabetic patients after open cardiac surgery in a large-scale study.Methods: The study design was a retrospective cohort. All adults who underwent open cardiac surgery between January 1st 2016-December 31st 2020 in 4 tertiary hospitals in Indonesia were included in the study. From a total of 4.931 samples included in the study, 3.753 patients were non-diabetic (Group I) and 1.178 were diabetic (Group II). Group II was divided into subgroup IIA (930 non-insulin-dependent) and subgroup IIB (248 insulin-dependent). The main outcome was in-hospital mortality of open cardiac surgery patients.Result: In-hospital mortality between group I and II had no significant difference (6.8% vs 5.7%; p = 0.188), as well as IIA and IIB (5.6% vs 6%; p = 0.782). Multivariate analysis demonstrated that diabetes did not increase mortality of open cardiac surgery (OR 0.665; p = 0.021). In-hospital mortality of subgroup IIB was higher than subgroup IIA, but insulin therapy did not increase the risk of in-hospital mortality (OR 1.259; p = 0.464).Conclusion: Both insulin-dependent and non-insulin-dependent diabetes mellitus were not the predictors of poor short-term outcomes for open adult cardiac surgery patients.

背景:胰岛素依赖型糖尿病患者通常血糖控制较差，并发症风险高于非胰岛素依赖型糖尿病患者。然而，这两组接受心脏直视手术患者的临床结果差异尚未确定。因此，本研究通过大规模的研究比较了胰岛素与非胰岛素依赖型糖尿病患者在心脏直视手术后的短期预后。方法:采用回顾性队列研究设计。所有在2016年1月1日至2020年12月31日期间在印度尼西亚4家三级医院接受心脏直视手术的成年人都被纳入研究。纳入研究的4931例样本中，非糖尿病患者3.753例(I组)，糖尿病患者1.178例(II组)，II组分为IIA亚组(930例非胰岛素依赖)和IIB亚组(248例胰岛素依赖)。主要观察指标为心内直视手术患者的住院死亡率。结果:I组和II组住院死亡率无显著差异(6.8% vs 5.7%;p = 0.188)，以及IIA和IIB (5.6% vs 6%;P = 0.782)。多因素分析表明，糖尿病不会增加心内直视手术的死亡率(OR 0.665;P = 0.021)。IIB亚组的住院死亡率高于IIA亚组，但胰岛素治疗并未增加住院死亡率的风险(OR 1.259;P = 0.464)。结论:胰岛素依赖型和非胰岛素依赖型糖尿病均不是成人心脏直视手术患者短期预后不良的预测因素。

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引用次数: 0

Comparison Between Norepinephrine-Epinephrine and Norepinephrine-Vasopressin Effectiveness in Reducing Mortality in Septic Shock: A Systematic Review 去甲肾上腺素-肾上腺素与去甲肾上腺素-加压素降低感染性休克死亡率的比较:一项系统综述

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2023-04-30 DOI: 10.20961/soja.v3i1.62121

K. Tan, Benedictus Benedictus, Christopher William Purnomo

Background: Sepsis is a state of organ dysfunction caused by the immune system’s abnormal response to an infection. Septic shock is sepsis complicated by circulatory and metabolic abnormalities, oftentimes resulting in death. Prompt identification and treatment of septic shock is crucial for the survival of patients. The latest international guideline recommends the administration of norepinephrine as the first line vasopressor, with the addition of epinephrine or vasopressin as an aid in achieving the target MAP (Mean Arterial Pressure).

Methods: This study is a systematic review of literatures from the databases Pubmed PMC, Science Direct, and Proquest. Systematic reviews on septic shock, norepinephrine, and epinephrine or vasopressin were among the inclusion criterias. This resulted in a total of five systematic reviews to be included in the qualitative synthesis.

Results: The five included studies were not in sync as to which vasopressor is best used for the treatment of septic shock patients. One of which did not compare the two combinations within the same category, two of which favored the use of norepinephrine-epinephrine, and the other two favored the use of norepinephrine-vasopressin for the treatment of septic shock patients.

Conclusion: The existing evidence were insufficient to give a conclusion of the best combination of vasopressors for septic shock patients. More research, specifically randomized controlled trials, needs to be conducted on this topic with well defined administration of combinations of vasopressors as an advancement of this systematic review. The writers also recommend the delay of anymore systematic reviews until the former recommendation has been met.

背景:败血症是一种由免疫系统对感染的异常反应引起的器官功能障碍状态。脓毒性休克是脓毒症并发循环和代谢异常，通常导致死亡。及时识别和治疗感染性休克对患者的生存至关重要。最新的国际指南建议将去甲肾上腺素作为一线血管加压剂，并添加肾上腺素或血管加压素，以辅助实现平均动脉压目标。方法:本研究对Pubmed PMC、Science Direct和Proquest数据库中的文献进行系统综述。系统评价脓毒性休克、去甲肾上腺素、肾上腺素或加压素的纳入标准。这导致定性综合中总共包含了五个系统评价。结果:五项纳入的研究在哪种血管加压药最适合用于感染性休克患者的治疗方面并不同步。其中一项没有比较同一类别内的两种组合，其中两种倾向于使用去甲肾上腺素-肾上腺素，另外两种倾向于使用去甲肾上腺素-加压素治疗感染性休克患者。结论:现有证据不足以得出感染性休克患者血管加压药物的最佳组合。更多的研究，特别是随机对照试验，需要在这个主题上进行，并明确血管加压药物的联合给药，作为本系统综述的进展。作者还建议，在满足之前的建议之前，不要再进行系统评价。

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引用次数: 0

A Technical Approach to Anesthesia in the Case of Tonsillectomy 扁桃体切除术麻醉的技术方法

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2023-04-30 DOI: 10.20961/soja.v3i1.60444

Febrian Dwi Cahyo, B. Sutanto, Iin Novita Nurhidayati Mahmuda

Background: Tonsillectomy is the most common surgical procedure performed by an ENT doctor (Throat Nose Ear) in children. This surgery can cause pain, bleeding and swelling in the injured throat. Patient may complain of pain, difficulty swallowing, eating, drinking disorders, nausea and vomiting and fall into a dehydrated state. This can reduce patient satisfaction.

Discussion: Postoperative pain management of tonsillectomy is a concern both by the ENT doctor and by the anesthesiologist. The high incidence of post-tonsillectomy pain or anxiety increases the risk of secondary post-tonsillectomy bleeding. It is necessary to know the mechanism of post operative pain and the negative impact of pain.

Conclusion: Doctors should give attention to reduce postoperative pain and choose a rational analgesic to overcome post operative tonsillectomy pain.

背景:扁桃体切除术是耳鼻喉科医生对儿童进行的最常见的外科手术。这种手术会导致受伤喉咙疼痛、出血和肿胀。患者可主诉疼痛、吞咽困难、进食、饮水障碍、恶心、呕吐和脱水。这会降低病人的满意度。讨论:扁桃体切除术后的疼痛管理是耳鼻喉科医生和麻醉师都关心的问题。扁桃体切除术后疼痛或焦虑的高发生率增加了扁桃体切除术后继发出血的风险。了解术后疼痛的发生机制和疼痛的负面影响是很有必要的。结论:医生应注意减轻术后疼痛，选择合理的镇痛药以克服扁桃体切除术后疼痛。

引用次数: 0

The Relationship of Renal Resistive Index and Central Venous Pressure As Predictors of Acute Kidney Injury in Critically III Patients of Intensive Care Unit Adam Malik General Hospital Medan 棉兰亚当马利克总医院重症监护室重症患者肾阻力指数与中心静脉压的关系及其对急性肾损伤的预测作用

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2022-10-31 DOI: 10.20961/soja.v2i2.59946

Muhammad Aripandi Wira, A. Hanafie, Asmin Lubis, B. Lubis

Background: Changes in the doppler-based renal resistive index (RRI) occur prior to the changes of glomerular filtration rate (GFR) during the development of acute kidney injury (AKI) and during the healing process from AKI. Central venous pressure (CVP) is not only a marker for resuscitation, but also can determine the microcirculatory perfusion pressure as outflow obstruction.

Objective: This study aims to determine the relationship between RRI and CVP as a predictor of AKI in critically ill patients admitted to the intensive care unit (ICU) of Adam Malik General Hospital.

Methods: This was an observational study with prospective cohort design and diagnostic test method. This research was conducted at the Adam Malik General Hospital Medan from June to July 2020. Forty patients aging 18-65 years old who met the diagnostic criteria of sepsis and septic shock were examined for RI and CVP when admitted to the ICU.

Results: RI had better sensitivity and specificity than CVP in predicting the incidence of AKI (sensitivity 68% vs 59%, specificity 77% vs 55.5%, Receiver operating characteristics (ROC) 0.870 vs 0.321 (95% confidence interval)).

Conclusion: Based on the results of this study, the renal resistive index has better sensitivity and specificity than central venous pressure in predicting the incidence of AKI in critical patients in the ICU.

背景:在急性肾损伤(AKI)的发展过程和AKI的愈合过程中，多普勒肾阻力指数(RRI)的变化发生在肾小球滤过率(GFR)的变化之前。中心静脉压(CVP)不仅是复苏的标志，而且可以作为微循环灌注压力的判断指标。目的:本研究旨在确定在亚当马利克总医院重症监护病房(ICU)入住的危重患者RRI和CVP之间的关系，并以此作为AKI的预测因子。方法:采用前瞻性队列设计和诊断试验方法进行观察性研究。该研究于2020年6月至7月在棉兰亚当马利克综合医院进行。40例年龄18-65岁符合脓毒症和脓毒性休克诊断标准的患者在入ICU时检查了RI和CVP。结果:RI预测AKI发生率的敏感性和特异性均优于CVP(敏感性68% vs 59%，特异性77% vs 55.5%，受试者工作特征(ROC) 0.870 vs 0.321(95%可信区间))。结论:基于本研究结果，肾抵抗指数在预测ICU危重患者AKI发生率方面比中心静脉压具有更好的敏感性和特异性。

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引用次数: 0

Anesthesia Management in Pregnancy with Heart Disorder using Walking Epidural Analgesia (WELA) 妊娠期心绞痛患者硬膜外行走镇痛的麻醉管理

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2022-10-31 DOI: 10.20961/soja.v2i2.59805

Yoram Yudhatama

Background: Heart disease in pregnancy is one of the leading causes of morbidity and mortality in pregnancy and childbirth. The intrapartum and postpartum periods are critical periods in which most of the deaths occur in this period. Manifestations appear in the form of heart failure which increases maternal and fetal morbidity and mortality.Case Illustration: We will report a case report of a 23-year-old woman with a diagnosis of G2P0A1 H 40 weeks, a single live intrauterine fetus with congestive heart failure due to rheumatic heart disease with mitral stenosis.Conclusion: The patient successfully underwent spontaneous labor under anesthesia facilitated by the walking epidural analgesia (WELA) technique with levobupivacaine and fentanyl agents which were administered continuously using a syringe pump during the labor process.

背景:妊娠期心脏病是妊娠和分娩期间发病率和死亡率的主要原因之一。分娩期和产后期是产妇死亡最多的关键时期。表现为心力衰竭，增加母体和胎儿的发病率和死亡率。病例说明:我们将报告一例23岁的女性，诊断为G2P0A1 H 40周，单个活宫内胎儿因风湿性心脏病合并二尖瓣狭窄导致充血性心力衰竭。结论:患者在麻醉下经硬膜外行走镇痛(WELA)技术，左布比卡因和芬太尼在分娩过程中持续使用注射泵给药，顺利完成自然分娩。

引用次数: 0

Combined Axillary Block with Spinal Block Anaesthesia 腋窝阻滞与脊髓阻滞联合麻醉

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2022-10-31 DOI: 10.20961/soja.v2i2.59188

Arsil Radiansyah, John Frans Sitepu, Luwih Bisono

Background: Patients undergoing upper limb trauma surgery have reported various benefits of regional anesthesia over general anesthesia, including better perioperative analgesia, less opiate use, less postoperative nausea and vomiting (PONV), and a shorter post-anesthesia care period. …………………………….. Case Illustration: We reported an evaluation of 72 years old, 165 cm height and 60 kg weight male patient who was planned for open reduction and internal fixation surgery for neglected left radius ulna close fracture and left neglected tibia fibula close fracture that he was beneath follow-up for hypertension (HT), and was using antihypertensive drugs. Preoperative risk of the patient was assessed as with American Society of Anesthesiologists (ASA) with score 3.General anesthesia would be unsafe due to geriatric issue, cardiovascular problem and delayed surgery term, we chosed to utilize combine axillary block with spinal block. we utilized USG guided infusion procedure in arrange to diminish local anesthetic dosage, and minimize error. During surgical procedure there is no hypotension, bradycardia or decreased oxygen saturation. Surgical anesthesia occurred in left hand within 20 minutes after drug delivery and 10 minutes in lower extremity. Surgery complications was not reported particularly related to vascular punction or adjacent anesthetic and nerve block applications. No complaint was detailed from the patient who was watched for 12 hours after the surgery.Conclusion: Peripheral nerve block and neuraxial block, when utilized appropriately in combination, appear be able to supplant common anesthesia within the larger part of case.

背景:接受上肢创伤手术的患者报告了区域麻醉比全麻的各种好处，包括更好的围术期镇痛，更少的阿片类药物使用，更少的术后恶心和呕吐(PONV)，以及更短的麻醉后护理期。...................................病例说明:我们报告了一名身高165 cm，体重60 kg的72岁男性患者，因左侧桡骨尺骨闭合性骨折和左侧胫骨腓骨闭合性骨折被忽视而计划行切开复位内固定手术，该患者因高血压(HT)未得到随访，并正在使用降压药。患者术前风险按照美国麻醉医师协会(ASA)评分3分进行评估。由于老年问题、心血管问题和手术期的延迟，全麻不安全，我们选择腋窝阻滞联合脊柱阻滞。我们采用USG引导输注程序，以减少局麻剂量，并尽量减少误差。手术过程中无低血压、心动过缓或血氧饱和度降低。手术麻醉在给药后20分钟内发生在左手，在给药后10分钟内发生在下肢。手术并发症没有特别与血管穿刺或邻近麻醉和神经阻滞应用有关的报道。手术后观察了12小时，患者没有详细的抱怨。结论:周围神经阻滞和轴神经阻滞在适当的情况下联合应用，在很大程度上可以替代普通麻醉。

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引用次数: 0

Implementation of Enhanced Recovery After Caesarean Section (ERACS) in Elective Procedure : A Case Report 选择性剖宫产术后增强恢复(ERACS)的实施:一例报告

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2022-10-31 DOI: 10.20961/soja.v2i2.58950

Sardimon Sardimon, Yusmalinda Yusmalinda, Zafrullah Khany Jasa, R. Rahmi, Fauzan Bachtiar Amin

Background: Enhanced Recovery After Cesarean Section (ERACS) protocol includes every component of the pre-operative, intra-operative and post-operative pathway. In the pre-operative phase, the protocol applied to this patient included the shortest possible fasting interval, oral intake of liquid carbohydrate and patient counselling. For intra-operative pathway, the components applied are prevention of hypotension, maintenance of normothermia, optimal uterotonic administration, IONV (intra-operative nausea and vomiting)/PONV (post-operative nausea and vomiting) prophylaxis, multi-modal analgesia and optimization of fluid administration. Post-operatively, the patient was given early nutritional intake, early mobilization, urinary catheter removal, venous thrombo-embolism prophylaxis, multi-modal analgesia and glycemic control. ERACS prove useful for early discharge, improving outcomes such as breastfeeding or reducing post-discharge opioid use.Case Illustration: A 31-year-old woman came with the chief complaint of fluid discharge since ± 3 hours prior to admission to the hospital. Based on the medical history, physical examination, and laboratory findings, the patient was diagnosed with premature rupture of membranes in a gestational age of 37-38 weeks and had a live, single-headed presentation of the fetus. Patient’s physical status is ASA II and scheduled for elective C-section procedure with spinal anesthesia.Conclusion: The implementation of the ERACS protocol in this case has been shown to reduce the rate of infection and post operative complications as well as reducing length of stay for the mother.

背景:增强剖宫产术后恢复(Enhanced Recovery After Cesarean Section, ERACS)方案包括术前、术中和术后路径的每个组成部分。在术前阶段，应用于该患者的方案包括尽可能短的禁食间隔，口服液体碳水化合物和患者咨询。对于术中通路，应用的成分包括预防低血压、维持体温、最佳子宫张力给药、IONV(术中恶心呕吐)/PONV(术后恶心呕吐)预防、多模式镇痛和优化液体给药。术后给予患者早期营养摄入、早期活动、拔除导尿管、预防静脉血栓栓塞、多模式镇痛及血糖控制。事实证明，ERACS有助于早期出院，改善诸如母乳喂养或减少出院后阿片类药物使用等结果。病例说明:一名31岁女性，入院前±3小时以液体排出为主诉。根据病史、体格检查和实验室结果，患者在妊娠37-38周时被诊断为胎膜早破，胎儿单头活产。患者身体状况为ASA II级，计划在脊髓麻醉下择期剖腹产。结论:在本病例中实施ERACS方案已被证明可以降低感染率和术后并发症，并缩短母亲的住院时间。

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引用次数: 0

Spinal Anesthesia in Caesarean Section with Ovarian Cyst Permagna with Meigs Syndrome 脊髓麻醉在子宫剖宫产伴Meigs综合征卵巢Permagna囊肿的应用

Solo Journal of Anesthesi, Pain and Critical Care (SOJA)

Pub Date : 2022-10-31 DOI: 10.20961/soja.v2i2.59961

A. Iqbal, S. Sembiring

Background: The ovarian cyst is the very common cyst intra-abdominal in the ovary. If it need termination, the common procedure is cesarean section then the best anesthesia technique that suitable is spinal anesthesia. The Meigs Syndrome is an uncommon clinical condition, in which benign ovarian tumors are usually accompanied by ascites and pleural effusion. About 1% of ovarian tumors can indicate Meigs syndrome. Meigs Syndrome case have been reported in woman before 30 years old.Case Illustration: We reported an evaluation of a 29 years old woman, Gestational 1 Partus 3 Abortus 0, 60 kg weight and 165 cm height came to hospital with enlargement of abdomen since 3 months ago. There wasn’t history of bleeding and fluid discharged from genital. There’s no complaint in urination and defecation. The patient has felt an enlarged abdomen since the age of 7 months of pregnancy during antenatal care to a obstetrician. The patient hemodynamic and vital signs are stable and the pregnancy already in 37-38th week. Based on that the obstetrician decided to terminate the pregnancy, we choose to do spinal anesthesia in the cesarean section because it’s easy, common, and best technique for short surgical procedures.Conclusion: In patient with Ovarian Cysts Permagna with Meigs Syndrome in Pregnancy, we need to understand the risk of complication of ovarian cyst is higher in the prenatal period than after birth. The diagnosis of fetal ovarian cyst should not affect the schedule and method of delivery. The management of Meigs Syndrome in Pregnancy this time we terminate the pregnancy because it’s already in 37-38th week, the spinal anesthesia management is nothing different with the normal pregnancy.

背景:卵巢囊肿是卵巢最常见的腹腔内囊肿。如果需要终止妊娠，常见的方法是剖宫产，那么最合适的麻醉技术是脊髓麻醉。Meigs综合征是一种罕见的临床疾病，其良性卵巢肿瘤通常伴有腹水和胸腔积液。约1%的卵巢肿瘤可提示梅格斯综合征。Meigs综合征病例多见于30岁以前的女性。病例说明:我们报告了一名29岁的女性，体重60公斤，身高165厘米，3个月前因腹部肿大而入院。没有生殖器出血和液体排出史排尿和排便均无不适。自怀孕7个月以来，患者在产科医生的产前护理中感到腹部肿大。患者血流动力学及生命体征稳定，妊娠已在37 ~ 38周。在产科医生决定终止妊娠的基础上，我们选择在剖宫产手术中进行脊髓麻醉，因为这是一种简单、常见、最短手术过程中最好的技术。结论:妊娠期Permagna卵巢囊肿合并Meigs综合征的患者，需要认识到产前发生卵巢囊肿并发症的风险高于出生后。胎儿卵巢囊肿的诊断不应影响分娩的计划和方法。妊娠Meigs综合征的处理这次我们终止妊娠因为已经是37-38周了，脊髓麻醉处理与正常妊娠没有什么不同。

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引用次数: 0