ACaseofPlacentalAbruptionAnesthesia

Name

BasicInformationPregnantfemale27y/o75kgnormalpregnancyfor38weeksMedicalhistory:

AfterCEAL4-5forclinicalpainlesslabourabout3hintheward,theobstetricdoctorsfoundasignificantincreaseinvaginalbleedingChiefcomplaint:SevereabdominalpainwithnoreliefafterCEAPasthistory:ThepatientwashealthybeforeAuxiliaryrecord

RBT:RBC3.58*1012/L,WBC4.9*109/L,Hb95g/L,PLT105*109/LCoagulationfunctiontest,3Ptest(-)prothrombintime11secondsUltrasoundexamination:anirregularliquiddarkareaofl.7cm*4.5cmbetweentheleftandthelowerpartoftheplacentaandtheuterinewallPre-evaluationASA:ШMallampati:ⅡClear,paleHypotention:BP80/40mmHg,HR120/minFHR:110-120bpmamoderateandaseverevariationofthedecelerationoccurredaboutevery20minutestoOR

Anesthesia

GA:CEAnoeffectandhypotensionMonitoring:BpECGSpO2Establishedintravenousaccess,resuscitationimmediatelybyrapidinfusionofcrystalsolutionabout1000-1500mlRapidinductionintubation:100%oxygen+etomidate0.2mg/kg+rocuronium40mg+remifentanil2μg/kgIntubation:generallaryngoscope,usedthecompressionofthecricoidpressureAnesthesia

0.5%~0.8%sevoflurance,untilchildbirthAfterchildbirth:Propofol(TCI1-2μg/ml+remifentanil(0.2μg/kg·h))+Sevoflurane(0.5-0.8%)maintainBIS40-60.Attheendofsurgery,neostigmine0.07mg/kgandgranisetron3mgWhenthepatientwasfullyawake,pulledouttheendotrachealtubeDiagnosis

1.Placentalabruption:(afterthe20thweekorduringdelivery)theseparationoftheplacenta(innormalsite)fromthesiteofuterineimplantationbeforedeliveryofthefetus2.Theearlystageofshock:hypotention,pale3.FetaldistressEvaluationandAnalysis

TimelyterminationofpregnancytoensurethesafetyofmotherandinfantTimelyexpansionofvolume,topreventtheoccurrenceofshockandcoagulationdisordersMaintainintraoperativeBISin40-60,adjustedtheanestheticdrug?sconcentrationtimelytopreventthedeepanesthesiaorintraoperativeawarenessFullyawakethenremovetheendotrachealtubetopreventaspirationGuidelinesThechoiceofanestheticdrugsshouldbeemphasizedonreducingtheimpactonthefetus,sowechosethedrugsstrictlyaccordingtotheFDAguidelines,mostofthemareclarifiedinBandC

FDAGuidelinesInductiondrugs:

EtomidateCKetamineC

MethohexitalB

PropofolBThiopentalCInhaledanesthetics:DesfluraneBEnfluorineBHalothaneCIsofluraneCSevofluraneB

FDAGuidelinesOpioidclass:AlfentanilCFentanylC

SufentanilCPethidineB

MorphineCBenzenetwonitrogen:DiazepamDMidazolamDNeuromuscularblockingagents:AtracuriumCCis-atracuriumBOurariCMiwakuatracuriumCPancuroniumCRocurroniumB

CholinechlorideCVecuroniumC

Summaryadequatepreparationreasonableanesthesiamethodanddrugscomprehensivemonitoringscientificregul