Weinstein Jacob, Muhalwes Rasha, Ronenson Alexander, Halpern Stephen H, Grisaru-Granovsky Sorina, Akawi Tamer, Gozal Yaacov, Shatalin Daniel, Ioscovich Alexander
Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with the Faculty of Medicine, The Hebrew University, 12 Shmu'el Bait Street, PO Box 3235, Jerusalem, Israel.
Department of Anesthesia, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Eur J Obstet Gynecol Reprod Biol X. 2024 Mar 21;22:100301. doi: 10.1016/j.eurox.2024.100301. eCollection 2024 Jun.
Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome.
This prospective cohort study was conducted from 1-Jan-2021 to 31-Dec-2021 at a single large obstetric centre of all repeat CS. We compared the characteristics and the appropriateness of the anesthesia techniques for low-order repeat CS (LOR-CS) (1 or 2 previous CS) and high order repat CS (HOR-CS) group (3 or more repeat CS).
During the study period, 1057 parturients met the study entry criteria, with 821 parturients in the LOR-CS group and 236 parturients in the HOR-CS group. The use of spinal anesthesia was more common for HOR-CS 84.3%. Overall surgical time varied between LOR-CS (38 min, 29-49) and HOR-CS (42 min, 31-57) (p = 0.004).The rate of moderate and severe adhesions was relatively high in HOR-CS and the duration of overall surgical time for cases with mild adhesions was 38 min (29-48), for moderate adhesions was 44 min (34.8-56.5), and for severe adhesions was 56 min (44.8-74.3). There was no significant difference in the Estimated Blood Loss (EBL) between LOR-CS and HOR-CS, with values of 653 ± 292 ml vs. 660 ± 285 ml, respectively.
Our data indicate that spinal anesthesia, standard monitoring and regular anesthetic setup are safe and suitable for the majority of HOR-CS, except in cases with high suspicion of placental accreta spectrum.
每一次重复剖宫产手术都可能增加手术复杂性。确定合适的麻醉策略以应对手术挑战对于母婴结局至关重要。
这项前瞻性队列研究于2021年1月1日至2021年12月31日在一家大型单一产科中心对所有重复剖宫产手术进行。我们比较了低阶重复剖宫产（LOR-CS，既往有1或2次剖宫产）和高阶重复剖宫产（HOR-CS，既往有3次或更多次重复剖宫产）组麻醉技术的特点和适宜性。
在研究期间，1057名产妇符合研究纳入标准，其中LOR-CS组821名产妇，HOR-CS组236名产妇。HOR-CS组中脊髓麻醉的使用更为常见，占84.3%。LOR-CS组的总体手术时间为38分钟（29 - 49分钟），HOR-CS组为42分钟（31 - 57分钟）（p = 0.004）。HOR-CS组中、重度粘连的发生率相对较高，轻度粘连病例的总体手术时间为38分钟（29 - 48分钟），中度粘连为44分钟（34.8 - 56.5分钟），重度粘连为56分钟（44.8 - 74.3分钟）。LOR-CS组和HOR-CS组的估计失血量（EBL）无显著差异，分别为653±292毫升和660±285毫升。
我们的数据表明，脊髓麻醉、标准监测和常规麻醉设置对于大多数HOR-CS是安全且合适的，但高度怀疑胎盘植入谱系疾病的病例除外。
