NYSORA News

Preeclampsia is a progressive hypertensive disorder of pregnancy that can have life-threatening complications for both the mother and the newborn. It is characterized by new-onset hypertension after 20 weeks of gestation, along with evidence of organ dysfunction. Affecting approximately 5% of pregnancies worldwide, preeclampsia is responsible for nearly 4.9% of maternal deaths in the United States. Maternal complications can range from stroke and heart failure to liver rupture and renal impairment, while newborns may experience growth restrictions, prematurity, and lifelong metabolic risks. Given its significant impact on maternal and fetal outcomes, perioperative management of patients with preeclampsia, particularly during cesarean delivery, is of critical importance. The review of Dennis et al. 2024 in Anesthesiology focuses on the role of anesthesiologists in optimizing care, mitigating risks, and improving perioperative outcomes for this high-risk population. Perioperative considerations for preeclampsia Anesthesiologists are integral to the management of preeclampsia in cesarean delivery, the most common major surgical procedure worldwide. Their role extends beyond intraoperative care to include: Preoperative risk assessment and optimization Intraoperative management of hypertension and hemodynamics Postoperative recovery, rehabilitation, and long-term follow-up Collaborative decision-making in a multidisciplinary care team Preoperative assessment and management A thorough preoperative evaluation is essential to assess disease severity and determine the safest anesthetic approach. Key considerations include: Hypertension severity: Preeclampsia can present with systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. Severe hypertension is defined as BP ≥ 160/110 mmHg and requires immediate treatment. Organ dysfunction: Complications such as cerebral edema, cardiac failure, renal impairment, hepatic dysfunction, and coagulopathy must be assessed. Diagnostic challenges: Other conditions, such as chronic hypertension, gestational hypertension, thrombotic microangiopathies, and acute fatty liver of pregnancy, can mimic preeclampsia and must be ruled out. Blood pressure management Nonsevere hypertension (140–159/90–109 mmHg): Treated with oral antihypertensives like labetalol, nifedipine, or methyldopa. […]

NYSORA News

Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising intervention for refractory cardiac arrest, particularly in perioperative settings. A recent retrospective study conducted at a high-volume extracorporeal membrane oxygenation (ECMO) center sheds light on the outcomes and effectiveness of perioperative ECPR. The findings highlight an impressive survival rate with favorable neurological outcomes, suggesting that early intervention with ECMO could be a game-changer in surgical and procedural settings. Key findings from the study A single-center retrospective review analyzed 33 adult patients who received extracorporeal CPR for perioperative cardiac arrest between January 2015 and August 2022. The study revealed: Survival to discharge: 57.6% of patients survived, a rate significantly higher than traditional CPR outcomes. Neurological outcomes: 89.5% of survivors had favorable neurological function (Cerebral Performance Category 1 or 2). Location trends: 73% of cases occurred in the cardiac catheterization laboratory, with the remaining in the operating room or interventional radiology suite. Impact of CPR duration: Survivors had significantly shorter CPR times (16.5 min vs. 25.0 min). Metabolic markers: Lower lactate levels (73 mg/dl vs. 115 mg/dl) and higher pH levels (7.17 vs. 7.03) were associated with better outcomes. These results suggest that perioperative cardiac arrest patients may benefit from a proactive ECMO strategy, particularly in well-equipped institutions. Understanding ECMO and perioperative ECPR ECMO is a life-support technique that temporarily replaces the function of the heart and lungs in critically ill patients. In perioperative cardiac arrest, ECMO can provide immediate circulatory support, allowing time for recovery and treatment of the underlying cause. When is ECMO used in perioperative cardiac arrest? Refractory cardiac arrest (no response to conventional CPR) Severe hemodynamic instability Pulmonary embolism or myocardial infarction leading to arrest Procedural complications in cardiac catheterization lab or operating room Young patients with reversible conditions Despite its benefits, ECMO is resource-intensive, requiring trained staff […]