فهرست مطالب سولماز فخاری

Laryngoscopy in women with severe preeclampsia is one of the most stressful anesthesia events; Laryngoscopy can stimulate hemodynamic responses in these women and lead to serious complications; Therefore, it is necessary to choose a safe method for laryngoscopy of these women; the aim of this study is to investigate the safety of Glidescope versus Macintosh blade in tracheal intubation for cesarean delivery in women with severe preeclampsia.

In a controlled prospective clinical trial, 70 pregnant women with severe preeclampsia candidates for cesarean section under general anesthesia were randomly assigned to one of the two groups of 35 Glidescope or Macintosh. Before induction of anesthesia, hemodynamic monitoring including heart rate, pulse oximetry, invasive arterial blood pressure was established. Tracheal intubation was performed in two Glidescope or Macintosh groups with the help of a Glidescope or Macintosh laryngoscope. Hemodynamic parameters were recorded 2 minutes before induction of anesthesia, before laryngoscopy and 1, 2, 3, 4, 5 and 10 minutes after tracheal intubation and compared between two groups.

High blood pressure in the first 5 minutes after intubation was more common in the Mackintosh group (P-value < 0.05). The rate of successful intubation was the same in both groups. The success rate in the first attempt was higher in the glidescope group (88.6% vs. 77.2%). The time required for intubation was longer in the Glidescope group (32.6±50.2 vs. 44.1±29.7 seconds, P - value = 0.03). The rate of airway complications was the same in both groups.

In airway management for cesarean section in a patient with severe pre-eclampsia, intubation with Glidescope, although it requires more time, creates a more acceptable hemodynamic situation than Mcintosh blade; It should be noted that the rate of airway complications is the same in the two groups; Therefore, safety of laryngoscopy with gladoscope in cesarean delivery of women with severe preeclampsia is acceptable.

Hypertension in obese patients is more affected by spinal anesthesia than normal people. Due to the lack of study and recommendation of articles about comparison of ephedrine and phenylephrine in obese patients during cesarean section, this study was performed with aim to compare the effect of hypotension treatment due to spinal anesthesia with ephedrine and phenylephrine on the status of arterial blood gas and Apgar score during cesarean delivery in obese mothers.

This randomized clinical trial was performed in 2016 on 100 pregnant women with BMI≥30kg/m2 (according to the formula) who were candidates for elective cesarean section in Tabriz Alzahra Hospital. Demographic characteristics and maternal and fetal status as well as analysis of arterial blood gases of umbilical artery were included in the researcher-made checklist. Data were analyzed by SPSS software (version 20) and t-test, Chi-square and Mann-Whitney U test. P< 0.05 was considered statistically significant.

There was statistically significant difference between two groups in terms of HCO3- (P=0.048), BE (P=0.035), heart rate (P=0.002), systolic (P=0.003) and diastolic (P=0.004) blood pressure during anesthesia and surgery; phenylephrine group had more stability. No significant difference was found between two groups in terms of other variables (blood pressure and arterial oxygen saturation) (P>0.06) and neonatal Apgar score (first and fifth minutes) (P>0.05).

Phenylephrine leads to better and more effective treatment of hypertension than ephedrine in pregnant women with BMI≥30kg /m2 with spinal anesthesia; also neonatal complications such as metabolic acidosis have been less observed in obese patients treated with phenylephrine.