Pulmonary hypertension is a disease that is afraid of hypercoagulable state. Hypercoagulable state can easily lead to pulmonary embolism, which will further aggravate right heart failure.
Sometimes in clinical practice, anticoagulant injections are required to treat this disease. The most common injection is low molecular weight heparin sodium.
Pregnant women need special treatment. For example, this patient had a hypercoagulable state during pregnancy, which caused blood clots in the original mechanical valve and required heart surgery as soon as possible.
How to deal with these contradictions. It is best to avoid heavy bleeding during the operation. As Dr. Du said, on the one hand, obstetricians should shorten the cesarean section as much as possible and let the anesthesiologist take over. On the other hand, the anesthesiologist should play the role of escorting the mother during the operation and try to help the mother survive the cesarean section.
After receiving Du Yeqing's call, anesthesiologist Dr. Mo arrived at the scene.
Dr. Mo first introduced the gynecologists: "The anesthesia plan should be planned for the patient according to the existing mature and effective plan. Cardiac surgery uses general anesthesia, and cesarean section can use continuous epidural anesthesia or continuous epidural anesthesia."
Why is general anesthesia not used for cesarean section?
In the past, anesthesiology has always believed that general anesthesia has many disadvantages for cesarean section, the biggest of which is that many general anesthetic drugs can easily enter the fetus and cause fetal respiratory depression. These drugs are the most commonly used and familiar drugs for anesthesiologists in general anesthesia. If these commonly used drugs are replaced with rarely used special drugs, they will be afraid of causing other troubles.
This patient is risking her own life just to have a child. She and her family are not willing to put the child's life at risk at this critical moment. Fetal respiratory depression means that the child will suffocate, and the baby may survive and suffer from cerebral palsy. For this reason, this patient and her family, who have obtained medical information from various sources, are unwilling to undergo general anesthesia.
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Is it possible to use continuous epidural anesthesia instead of general anesthesia?
In this regard, the anesthesiologist and cardiac surgeon dare not give a 100% guarantee, and may switch to general anesthesia during the operation depending on the situation. The main reason is that the patient's heart function is not good at the moment, and other circulatory support may be required during the operation.
Du Yeqing said: "If the patient's condition is more critical, we may provide her with IABP support in advance."
(What IABP is has been mentioned in the previous chapter and will not be repeated here.)
In this case, how can we ensure that the contingency plans we are making now are feasible?
"Director Zhang presided over the ward rounds discussion this morning. We will change her medication combination today. It is estimated that the patient's condition will improve by tomorrow." Du Yeqing said.
It turns out that the big boss took action.
"Of course, according to our Director Zhang's prediction, this drug can only last until the day after tomorrow." Du Yeqing added that it is not that it should not be used before, but that the drug should be used at the critical period. Some drugs seem to work quickly, but to be frank, they do not cure the root cause. After using them, they soon become ineffective.
After listening to this, Du Haiwei knew that the surgeons, cardiologists and interventional doctors from the cesarean section center would be on guard, so they, the obstetricians and gynecologists, would not be too frightened.
While the meeting was going on, someone came quietly and sat next to Zhang Huayao, secretly waved to Xie.
Xie Wanying turned around and saw Senior Brother Shen, who was present, with his handsome eyebrows raised in smile.
At the scene, all the doctors of the surgical team except the neonatologist were basically present, and any issues could be discussed openly.
Du Haiwei turned around and asked the young doctors in the group, hoping to gather their ideas: "Tell us what you think about this operation. If you have any good suggestions, please share them and let's discuss them together."
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