Hemodynamic Changes Associated With Propofol And Remifentanil In Severe Preeclampsia

BackgroundSevere preeclampsia in critical condition,is one of leading causes of maternal mortality. Cesarean section is the most effective mean to rescue of the patients with severe preeclampsia. However, the patients with severe preeclampsia are both in the gestation period and having the special pathology physiology changes in circulatory system. The unique hemodynamics of them is greatly different from normal parturient women. Furthermore, some of them do not adapt or even are existing contraindication to the intrathecal anesthesia, such as coagulation disorders, liver function lesion, PLT decreasing and so on. So they have to choose general anesthesia for Cesarean section. General anesthesia on pregnant women undergoing cesarean section exist distinctiveness. Whether maintaining the enough anesthesia depth to guarantee that the pregnant woman circulates stably,or avoiding the general anesthesia medication as far as possible to effect the embryo.Propofol and remifentanil are ones of the most widely used intravenous anesthetic,but there is a dispute constantly on its useing in obstetric anesthesia. As the research and using experience gradually deepened, they are beginning to use in obstetric. In recent years, papers about clinical application of general anesthesia in cesarean section are so many. However, the evaluations of the cycle are only the heart rate and blood pressure measurements. In healthy patients, the maximum change in CO has been shown to correlate better with uteroplacental blood flow than upper arm blood pressure. Furthermore, in severe preeclampsia, an increased systemic vascular resistance (SVR) could render blood pressure a poor indicator of CO, but the information available on such patients during GA is scanty.It is necessary to investigate the hemodynamic changes during GA for cesarean delivery in severe preeclampsia. A better understanding of the perioperative hemodynamic changes could contribute to a reduction in perioperative pulmonary edema, renal dysfunction, eclampsia, and neonatal morbidity.PurposeTo observe the hemodynamic effects and changes, of which the patients with severe preeclampsia on general anesthesia for cesarean section using propofol and remifentanil.MethodsAdult patients aged 21-39 years old with ASA physical status II- III grade were scheduled for elective cesarean section. Being existing contraindication to the intrathecal anesthesia,they had to get general anesthesia for Cesarean section and chose Propofol and remifentanil. The patient was put right internal jugular vein catheterization, measuring central venous pressure(CVP)continuously. Put left radial artery puncture, arterial monitoring, measuring mean arterial blood pressure(MAP)continuously. Being used the GE ICG noninvasive hemodynamic monitoring system to measure cardiac output(CO),Stroke Volume (SV) , systemic vascular resistance (SVR). Hemodynamic values were measured in the following defined time.1.Baseline measurements T12.Induction of anesthesia T2(induction of GA until intubation) 3.Intubation T3(the 30-s period during intubation )4.After intubation T4(from intubation to 10 minutes before skin incision)5.Skin incision T5 (from skin incision to 30 s before uterine incision)6.Postdelivery T6(the 30-s period from delivery to administration of oxytocin)7.Peak oxytocin effect T7 (from administration of oxytocin to peak effect on CO)8.End of surgery T8(30-s time period before skin closure)9.Tracheal extubation T9(30-s time period during tracheal extubation)10.Leaving operating room T10(30-s time period before leaving the operating room)Results1. Intraoperative hemodynamic changes in patients MAP at T9,SVR at T10,CO at T2,T3,T4,T5,T6,T8,T9,T10,HR at T2,T3,T4,T5,T6,T8,T10,SV at T2,T3,T4,T5,T6,T8,T9,T10,CVP at T2,T3,T4,T5,T6,T7,T8,T9,T10 comparing with the ones at T1 all were no significant difference,P>0.05。MAP at T2,T3,T4,T5,T6,T7,T8,T10 were lower than the ones at T1;SVR at T2,T3,T4,T5,T6,T7,T8,T9 were lower than the ones at T1;CO at T7 was higher than the one at T1;HR at T7,T9 was higher than the one at T1;SV at T7 was higher than the one at T1,P<0.05.2. Effective of the infant. This study shows that all the infants were PLBW. Two infants'1min Apgar score were 3 points 1, twelve infants'were 4-7 points, two one's more than 8 points. Through the using of naloxone, mask oxygen, assisted ventilation, stimulation of respiratory and other simple treatment, all the infants'5min 10minApgar scores were more than 8 points.Conclusion1.General Anesthesia using propofol and remifentanil in severe preeclampsia was associated with clinically insignificant changes in CO and available to reduce the afterload.2.General Anesthesia using conventional dose of propofol and remifentanil in severe preeclampsia can ensure the cardiac output,can be little effective on respiratory of the PLBW.3.Patients with severe preeclampsia perioperative cesarean section, conventional—dose oxytocin have significantly short -term fluctuations in hemodynamics.