Anesthetic management of prophylactic cervical cerclage: a retrospective multicenter cohort study
Anesthetic management of prophylactic cervical cerclage: a retrospective multicenter cohort study
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DOI：
10.1007/s00404-014-3391-5
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发表时间：
2015-03-01
影响因子：
2.6
通讯作者：
Ginosar, Yehuda
中科院分区：
文献类型：
--
作者：
Ioscovich, Alexander;Popov, Alla;Ginosar, Yehuda
宫颈功能不全使大约1/500的孕妇复杂化，是中期自然流产和早产的最常见原因。没有前瞻性或大规模的回顾性研究比较区域麻醉和全身麻醉用于宫颈环扎。在IRB批准后，我们在两个主要医学中心进行了一项为期8年的回顾研究，以评估麻醉选择与麻醉和产科结果的关系。从2005年1月1日至2012年12月31日，对所有接受宫颈环扎术失败的患者的麻醉和围手术期细节进行了回顾性收集。详细信息包括人口统计数据、麻醉技术、PACU数据和围手术期并发症。在研究期间，我们确定了327名妇女中的487例宫颈环扎术。最常用的麻醉方法是全身麻醉(GA)(402/487，82.5%)，而区域麻醉(RA)(85/487，17.5%)。GA时最常用的方法是口罩(275/402，68.4%)，其次是静脉深度镇静(61/402，15.2%)、LMA(51/402，12.7%)和气管插管(13/402，3.2%)。接受全身麻醉和区域麻醉的女性在人口统计学特征上没有显著差异。平均缝合时间GA组为9.8+/-A1.6min，RA组为10.6+/-A2.1min(p<；0.001)。在手术室的平均停留时间GA组为20.5±-A3.9分钟，RA组为23+/-A4.6分钟(p<；0.001)。接受GA治疗的患者在PACU中接受了更多的阿片类药物(6.2%比1.2%；p<；0.001)和更多的非阿片类止痛药(36.8%比9.4%；p<；0.001)。GA组的PACU停留时间(49.5A18min)短于RA组(62.4A28min；p<；0.001)。两组之间在麻醉或围手术期的结果没有其他差异。这项研究的目的并不是为了提供证据证明RA可以减少母体麻醉引起的肺吸入、呼吸道并发症或胎儿神经不良反应的风险。区域麻醉和全身麻醉都可以安全地用于环扎术。全麻后患者苏醒时间较短，但对阿片类和非阿片类镇痛的需求较高。
Cervical incompetence complicates approximately 1 in 500 pregnancies and is the most common cause of second-trimester spontaneous abortion and preterm labor. No prospective or large retrospective studies have compared regional and general anesthesia for cervical cerclage.Following IRB approval, we performed a retrospective study in the two main medical centers over an 8-year period to assess the association of anesthesia choice with anesthetic and obstetric outcomes. Anesthetic and perioperative details were retrospectively collected from fails of all patients undergoing cervical cerclage from 01/01/2005 until 31/12/2012. Details included demographic data, anesthetic technique, PACU data and perioperative complications.We identified 487 cases of cervical cerclage in 327 women during the study period. The most commonly used anesthetic technique was general anesthesia (GA) (402/487; 82.5 %) compared with regional anesthesia (RA) (85/487; 17.5 %). When GA was performed, facemask was the most commonly used technique (275/402; 68.4 %), followed by intravenous deep sedation (61/402; 15.2 %); LMA (51/402; 12.7 %) and tracheal intubation (13/402; 3.2 %). There were no significant differences in demographic characteristics between women receiving general and regional anesthesia. Average duration of suturing the cervix among the GA group was 9.8 +/- A 1.6 and 10.6 +/- A 2.1 min in the RA group (p < 0.001). Average length of stay in the operating room in the GA group was 20.5 +/- A 3.9 and 23 +/- A 4.6 min in the RA group (p < 0.001). Patients receiving GA received in the PACU more opioids (6.2 versus 1.2 %; p < 0.05) and more non-opioids analgesics (36.8 versus 9.4 %; p < 0.001). Duration of PACU stay was shorter after GA (49.5 +/- A 18 min) than after RA (62.4 +/- A 28 min; p < 0.001). There were no other differences in anesthetic or perioperative outcome between groups. This study was not designed to provide evidence that RA reduces the risk of pulmonary aspiration, airway complications or adverse fetal neurological effects from maternal anesthetic exposure.Both regional and general anesthesia were safely used for the performance of cerclage. Patients after general anesthesia had a shorter recovery time but a higher demand for opioids and non-opioids analgesia.