RESUMO
The medical records of firstly diagnosed patients with the discharge diagnosis contained " placenta implantation,cesarean section" at Peking University Third Hospital from 2012 to 2016,were collected.The records included the type of placenta implantation,anesthetic methods,intraoperative blood loss,abdominal aorta balloon placement,hysterectomy,requirement for intensive care unit (ICU) admission and length of hospital stay,and the anesthetic management experience was summarized in the patients with placenta implantation undergoing cesarean section.A total of 156 patients were included in this study,and among the 156 patients,there were 70 cases of accreta (44.9％),50 cases of increta (32.1％) and 36 cases of percreta (23.1％).The intraoperative blood loss was (624±451) ml,(2100±1283) ml and (5281 ±3114) ml,the ratio of neuraxial anesthesia was 92％,62％ and 14％,the ratio of neuraxial anesthesia combined with general anesthesia was 4％,20％ and 61％,and the ratio of general anesthesia was 4％,18％ and 25％ in the patients of accreta,of increta and of percreta,respectively.The abdominal aorta balloon was placed during surgery in 14 cases,and among the 14 cases,there were 3 cases of increta and 11 cases of percreta.Forty-nine patients were transferred to ICU after operation,and among the 49 patients,there was 1 case of accreta,16 cases of increta and 32 cases of percreta.Anesthesiologists should pay attention to the preoperative interview and assessment,actively try to work with multi-departments,make anesthetic regimen according to patient's condition,closely monitor patient's vital signs during operation,concern about the operating process and blood loss,and ensure proper infusion and transfusion for the patients with placenta implantation undergoing cesarean section,and in addition,the critically ill patients should be transferred to ICU after operation for intensive monitoring and treatment.
RESUMO
Objective:To investigate the anesthetic choice for patients undergoing cesarean section complicated with placenta implantation.Methods: A retrospective case review of the patients with placenta implantation between 2008 and 2013 at Peking University Third Hospital was conducted in the International Classification of Diseases (ICD)-9 codes,excluding natural birth and not first diagnosed in our hospital,a total of 96 cases were incorporated into this study.According to the degree of implantation,they were divided into three groups: accreta group,increta group and percreta group.We analyzed the time from the start of surgery to baby delivery and the anesthetic technique.Results: The accreta group included 49 cases,the increta group 33 cases,and the percreta group 14 cases.The average time from the start of surgery to fetus delivery in the three groups were (6.7±3.0) min,(7.2±4.6) min,and (11.9±4.9) min,and the percreta group was significantly different from the accreta group and the increta group (P<0.05).There were significant differences among the three groups in anesthetic choices (P<0.001): in the accreta group,45 cases (91.8％) underwent spinal anesthesia,2 cases (4.1％) underwent general anesthesia,and 2 cases (4.1％) were converted to general anesthesia after spinal anesthesia during the operation;in the increta group,22 cases (66.7％) underwent spinal anesthesia,4 cases (12.1％) underwent general anesthesia,and 7 cases(21.2％) were converted to general anesthesia after spinal anesthesia;in the percreta group,2 cases (14.3％) underwent spinal anesthesia,2 cases (14.3％) underwent general anesthesia,and 10 cases (71.4％) were converted to general anesthesia after spinal anesthesia.Conclusion: Spinal anesthesia can be used as the first choice of cesarean section complicated with placenta implantation and general anesthesia should be considered in placenta percreta.
RESUMO
Intraoperative cell salvage (IOCS) has been widely used to reduce allogeneic blood transfusion and prevent blood transfusion related complications during surgery.However, due to the risk of transfusion related reaction, contamination, and immunological reaction, its use for tumor patients has been controversial and limited.To explore the feasibility of the application of IOCS in cancer patients, we reported 2 cases of renal cell carcinoma (RCC) with tumor embolism in IVC that underwent radical nephrectomy,and inferior caval venous thrombectomy receiving IOCS combined with leukocyte depletion filter (LDF) from August 2016 to November 2016 in our hospital.The cell saver blood salvage (Haemone-tics, 5+) was used for these 2 cases.The salvaged blood was filtered through the LDF before infusion.For case 1 (male 45-year-old) the total operation time was 505 min, and the estimated blood loss was 4 500 ml.A total of 1 000 mL autologous blood, 12 u allogeneic packed red blood cells (PRBC), 1 200 mL fresh frozen plasma (FFP) were infused during the procedure.The patient was discharged from hospital after 75 days without complications.The postoperative follow-up for 3 months showed no tumor recurrence or metastasis.For case 2 (a male patient, aged 51 years), the total operation time was 490 min, and the estimated (blood loss was 7 000 mL.the patient received 2 700 mL autologous blood transfusion, 12 u allogeneic packed red blood cells (PRBC), and 2 400 mL fresh frozen plasma (FFP).The patient was discharged from hospital after 86 days without severe complications.the postoperative follow-up for 6 months showed no tumor recurrence or metastasis for this patient.Other relevant retrospective studies with this technique showed that cell salvage could be used safely in many kinds of cancer patients, for example, bladder cancer, liver cancer and kidney cancer.Furthermore,numerous researches have proved the safety and efficacy of the combination of these two techniques, the intraoperative cell salvage technique and leucocyte depletion filter in cancer patients.Here we only reported two cases using IOCS and LDF.Further work is needed to determine whether the use of intraoperative cell salvage combined with leukocyte depletion filter can be used safely for patients with HCC.