Eclampsia y anestesia

Manejo de la pre-eclampsia: temas para anestesiólogos


Management of pre-eclampsia: issues for anaesthetists.
Dennis AT.
Department of Anaesthesia, The Royal Women's Hospital Parkville, and Department of Pharmacology, The University of Melbourne, Victoria, Australia. adennis@unimelb.edu.au
Anaesthesia. 2012 Sep;67(9):1009-20. doi: 10.1111/j.1365-2044.2012.07195.x. Epub 2012 Jun 26.
Abstract
Pre-eclampsia is a leading cause of maternal morbidity and mortality. Substandard care is often present and many deaths are preventable. The aim of this review is to summarise the key management issues for anaesthetists in the light of the current literature. A systematic literature search of electronic databases was undertaken including MEDLINE, EMBASE and the Cochrane Library using the key words obstetrics, pregnancy, pregnancy complications, maternal, pre-eclampsia, preeclampsia, cardiac function, haemodynamics, haemolysis, elevated liver enzymes, low platelets (HELLP), eclampsia, anaesthesia, anesthesia, neuraxial. Relevant Colleges and Societies websites were examined for pertinent guidelines. The disease is defined within the context of hypertensive diseases, and early recognition of pre-eclampsia and its complications, as well as multidisciplinary expert team management is highlighted. Accurate monitoring and recording of observations including the use of transthoracic echocardiography is discussed. The importance of the treatment of systolic blood pressure>180 mmHg and the use of intravenous antihypertensive medication as well as the use of parenteral magnesium sulphate for the treatment and prevention of eclampsia is emphasised . Restricted intravenous fluid therapy and avoidance of ergometrine is discussed. Neuraxial analgesia and anaesthesia, and general anaesthesia for birth is summarised as well as postpartum management including analgesia, thromboprophylaxis, management of acute pulmonary oedema and the use of pharmacological agents in the setting of breastfeeding.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2012.07195.x/pdf


Avances recientes en el manejo de la pre-eclampsia


Recent Advances In Management Of Pre-Eclampsia
Pallab Rudra, Sonela Basak, Dilip Patil and M Y Latoo
BJMP 2011;4(3):a433
Pre-eclampsia is a multisystem disorder of pregnancy that forms an integral part of the spectrum known as hypertensive diseases of pregnancy. The National High Blood Pressure Education Program (NHBPEP) Working Group1classifies hypertensive diseases in pregnancy into 4 groups:
1) Gestational hypertension
* New onset hypertension in pregnancy presenting after 20 weeks
* No proteinuria
* BP returns to normal less than 12 weeks postpartum
* Final diagnosis made only postpartum
2) Chronic hypertension
* BP >140/90 mm Hg before pregnancy or diagnosed before 20 weeks gestation not attributable to gestational trophoblastic disease
or
* Hypertension first diagnosed after 20 weeks gestation but persistent after 12 weeks postpartum.
3) Pre-eclampsia/eclampsia
* BP > 140/90 mm Hg after 20 weeks gestation in a women with previously normal blood pressure
* Proteinuria (>0.3 gm urine protein in 24 hr).
* Eclampsia is defined as seizures that cannot be attributed to other causes in a woman with pre-eclampsia
4) Superimposed pre-eclampsia (on chronic hypertension)
* New onset proteinuria (>300 mg/24 hr) in a woman with hypertension but no proteinuria before 20 weeks gestation
* A sudden increase in proteinuria or blood pressure, or platelet count less than 100,000 in women with hypertension and proteinuria before 20 weeks gestation

http://www.bjmp.org/files/2011-4-3/bjmp-2011-4-3-a433.pdf






Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org