剖宫产动脉切换手术患者的麻醉管理：单中心病例系列（2015-2023）

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-02-01 DOI:10.1016/j.ijoa.2024.104299

S. Goto, Y. Suzuki, S. Kurokawa, Y. Nagasaka

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引用次数: 0

摘要

背景：动脉转换手术（ASO）治疗大动脉右转是40年前发展起来的，ASO患者已达到生育年龄。虽然接受ASO的孕妇中有40%以上通过剖宫产分娩，但关于麻醉管理的详细信息尚未报道。本研究的目的是评估麻醉和围手术期结局的孕妇ASO剖宫产。方法：回顾性分析2015年1月1日至2023年5月31日在东京女子医科大学医院剖宫产的有ASO病史的孕妇。分析了产科和麻醉管理以及产妇结局。结果：10例ASO患者共12例剖宫产。剖宫产时产妇年龄中位数为29岁（范围：26-38岁），胎龄中位数为37周零1天（33周零6天- 37周零6天）。2例患者在妊娠期间发生心律失常（阵发性室上性心动过速、非持续性室性心动过速和房性心动过速）。5例患者表现为中度至重度瓣膜反流，其中3例在妊娠期间恶化。所有患者均行剖宫产神经轴麻醉。4例发生脊柱性低血压，立即给予血管加压药物治疗。无患者术后出现心力衰竭或心律失常。结论：有ASO病史的孕妇行轴向麻醉剖宫产结局良好，无术后心脏并发症。

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Anesthesia management for cesarean delivery in patients with an arterial switch operation: a single center case series (2015–2023)

Background

Arterial switch operation (ASO) for dextro-transposition of the great arteries was developed four decades ago, and women with ASO have reached childbearing age. Although over 40% of the pregnant women who received ASO gave birth via cesarean delivery, detailed information about anesthesia management has not been reported. This study aimed to evaluate anesthesia and perioperative outcomes in pregnant women with ASO undergoing cesarean delivery.

Methods

A retrospective chart review was conducted on pregnant women with a history of ASO with a cesarean delivery at Tokyo Women’s Medical University Hospital between January 1, 2015, and May 31, 2023. Obstetric and anesthetic management, as well as maternal outcomes, were analyzed.

Results

A total of 12 cesarean deliveries among 10 ASO patients were identified. The median maternal age at cesarean delivery was 29 years (range: 26–38) and median gestational age was 37 weeks and 1 day (33 weeks and 6 days – 37 weeks and 6 days). Two patients developed arrhythmia (paroxysmal supraventricular tachycardia, non-sustained ventricular tachycardia, and atrial tachyarrhythmia) during pregnancy. Five patients presented with moderate to severe valvular regurgitation, three of which worsened during pregnancy. All patients received neuraxial anesthesia for the cesarean delivery. Spinal induced hypotension occurred in four cases, which was immediately treated with vasopressors. No patient developed heart failure or arrhythmias postoperatively.

Conclusion

Neuraxial anesthesia for cesarean delivery in pregnant women with a history of ASO resulted in favorable maternal outcomes with no postoperative cardiac complications.

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.