고혈압을 동반한 산모의 제왕절개술 마취의 임상적 고찰 (10년간의 후향적 연구) = Clinical evaluation of anesthesia for cesarean section of the patients with hypertensive disorders in pregnancy: retrospective study for 10 years

다국어 초록 (Multilingual Abstract)

Background: There are many difficulties in anesthetic management
for cesarean section of the patients with hypertension. The
anesthetic management of hypertensive disorders in pregnancy has
been controversial.
Methods: We reviewed the medical records of the patients with
hypertensive disorders in pregnancy from Jan., 1998 to Dec., 2007,
and made clinical analysis of the anesthesia for cesarean section.
Results: Of the total 775 parturients with hypertensive disorders,
638 (82.3%) was delivered by cesarean section. Indications for
cesarean section were, in order of frequency, hypertensive disorders
in pregnancy (36.9%), multiple pregnancy (13.8%), previous cesarean
section (11.6%), etc. Of the total cesarean section, 468
(73.4%) were emergency cases. The majority of preoperative
systolic blood pressures were 141−160 mmHg (36.2%) and 161−
180 mmHg (35.2%). The majority of preoperative diastolic blood
pressures were 91−100 mmHg (28.6%) and 101−110 mmHg
(25.0%). 350 (54.9%) had epidural anesthesia, 195 (30.5%) had
general anesthesia, and 93 (14.6%) had spinal anesthesia.
Estimated blood loss was significantly lower after regional
anesthesia than after general anesthesia. In patients received
magnesium sulfate (MgSO4), (40.0% of total) 83.5% had regional
anesthesia and 16.5% had general anesthesia. In the cases with
MgSO4 1 min Apgar score was lower and neonatal birth weight was
smaller than in cases without MgSO4.
Conclusions: Anesthesiologist must have much attention on the
prevention, treatment and anesthetic management for cesarean
section of patients with hypertensive disorders in pregnancy.

참고문헌 (Reference)

1 김지향, "임신 중 고혈압 질환의 제왕절개술 마취에 대한 임상적 고찰" 대한산부인과학회 50 (50): 865-871, 2007

2 Cunningham FG, "Williams Obstetrics. 22nd ed" McGraw-Hill Company 7-12, 2005

3 Park JH, "Toxemia of pregnancy (1964-1966)" 11 : 455-458, 1968

4 Lipshitz J, "The effect of hydralazine on placental perfusion in the spontaneously hypertensive rat" 156 : 356-359, 1987

5 Alexander JM, "Selective magnesium sulfate prophylaxis for the prevention of eclampsia in women with gestational hypertension" 108 : 826-832, 2006

6 Sharwood-Smith G, "Regional anaesthesia for caesarean section in severe preeclampsia: spinal anaesthesia is the preferred choice" 8 : 85-89, 1999

7 Moore LE, "Recurrent risk of adverse pregnancy outcome" 35 : 459-471, 2008

8 Hjartardottir S, "Recurrence of hypertensive disorder in second pregnancy" 194 : 916-920, 2006

9 Wallace DH, "Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia" 86 : 193-199, 1995

10 Cheek TG, "Pregnancy-induced hypertension. in: Anesthetic and Obstetric Management of High-Risk Pregnancy. 2nd ed" Mosby 386-411, 1996

11 Byun JS, "Pregnancy-induced hypertension in Korea" 36 : 737-754, 1993

12 Aya AG, "Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison" 97 : 867-872, 2003

13 Fernando R, "Ostheimer “What’s new in obstetric anesthesia” lecture" 106 : 615-621, 2007

14 Korean Society of Obstetrics and Gynecol, "Obstetrics. 4th ed" Koonja Publishing Inc 725-760, 2007

15 Breen TW, "Obstetric anesthesia practice in Canada" 47 : 1230-1242, 2000

16 Choi DH, "Obstetric anestheia. in: Anesthesia" Koonja Publishing Inc 1886-1890, 2002

17 Zuspan FP, "New concepts in understanding of hypertensive disease during pregnancy" 18 : 161-166, 1991

18 Panchal S, "Maternal mortality during hospital admission for delivery; a retrospective analysis using a state-maintained database" 93 : 134-141, 2001

19 Wali A, "Maternal morbidity, mortality, and risk assessment" 26 : 197-230, 2008

20 Okafor UV, "Maternal and fetal outcome of anaesthesia for caesarean delivery in preeclampsia/eclampsia in Enugu, Nigeria: a retrospective observational study" 14 : 108-113, 2005

21 Roberts JM, "Is oxidative stress the link in the two-stage model of pre-eclampsia?" 354 : 788-789, 1999

22 Oh YO, "Hypertensive disorders in pregnancy (Toxemia), 598 cases" 19 : 913-925, 1976

23 Dyer RA, "Hemodynamic changes associated with spinal anesthesia for cesarean delivery in severe preeclampsia" 108 : 802-811, 2008

24 Karaman S, "Epidural versus spinal anesthesia for cesarean section in preeclamptic patients" 90 : 68-69, 2005

25 Clark VA, "Ephedrine requirements are reduced during spinal anaesthesia for caesarean section in preeclampsia" 14 : 9-13, 2005

26 Lee GY, "Clinical evaluation of anesthesia for cesarean section of toxemia" 14 : 185-191, 1981

27 Bang EC, "Clinical evaluation of anesthesia for cesarean section of the patients with pregnancy induced hypertension" 7 : 63-70, 2005

28 Alper MH, "Anesthetic management of the high risk pregnancy" 2 : 609-, 1973

29 Hawkins J, "Anesthesia and preeclampsia/eclampsia. in: Obsteric Anesthesia. 2nd ed" Lippincott Williams & Wilkins 501-523, 1999

30 Byun JS, "A clinical study of pregnancy-induced hypertension (PIH) in Korea in the last 7 years" 43 : 2283-2292, 2000