Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Nov 2012
Clinical Trial[Neuro-autonomic inhibition and haemodynamics management optimization during cesarean section under spinal anaesthesia in pregnant women with gestosis].
Results showed that autonomic nervous system (ANS) and blood circulation system (BCS) dysfunction in 3rd trimester pregnant women with gestosis are more pronounced, than in healthy pregnant women, despite the prescribed treatment. The most significant disturbances were vagotonia and hypokinetic haemodynamics type (often iatrogenic). Spinal anaesthesia (SA) during Cesarean section in pregnant women is accompanied by blood pressure decrease to the level demanding on vasopressors use. ⋯ Atropine introduction in pregnant women with vagotonia and hypokinetic haemodynamics type (often iatrogenic, owing to irrational therapy) before SA beginning of promoted neurovegetative inhibition optimization and haemodynamics stabilization in eukinetic range. Vagus blockade (elimination of ANS dysfunction) was accompanied by more physiologic sympathicotonia development with smaller decrease of blood pressure (without stroke index reduction!), absence of bradycardia and vomiting. Research showed that the blood pressure cannot be the only objective criterion of vasopressors use.
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Peculiarities of septic shock in obstetrics are considered in this article. Traits of pregnant woman organism concerning infectious process, etiology and risk factors, modern criteria of heavy sepsis diagnosis and septic shock are discussed. It is pointed out that septic process system manifestations considerably outstrips local manifestations of purulent process in a uterus and it is necessary to take into account modern markers and criteria when making decision on initial infection center sanitization. The modern protocol of septic shock initial intensive therapy where are defined not only modern methods of treatment, but also time of their implementation, and the basic principles of pyosepsis caused maternity mortality decrease.