[Anesthesia in pregnant women with HELLP syndrome: case report]

Anesthetic Management in a Post-COVID Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Patient in Rural Central India: A Close Shave

Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a dangerous complication of pregnancy amounting to significant mortality and morbidity. While conducting a cesarean delivery for such cases special care and consideration have to be taken in order to prevent maternal mortality. Thrombocytopenia is a significant abnormality that has to be weighed before induction in cases of HELLP syndrome with no clear cut-off value for the administration of neuraxial anesthesia. This case report aimed to explain the anesthetic management of a case with an indication for an emergency cesarean delivery.

Remifentanil inhibits the traumatic stress response in emergent trauma surgery

OBJECTIVE

The aim of this study was to explore whether remifentanil could inhibit the stress response in emergent trauma surgery more effectively than sufentanil.

PATIENTS AND METHODS

Sixty trauma patients for emergent surgery were randomly divided into remifentanil group (R group, n = 30) or sufentanil group (S group, n = 30). The patients in the R group were continuously intravenously infused with remifentanil, while those in the S group were administrated with sufentanil. The plasma contents of cortisol (COR), epinephrine (E), norepinephrine (NE), and blood glucose were measured before anesthesia induction (T1), 5 minutes after intratracheal intubation (T2) and 5 minutes (T3), 30 minutes (T4), and 1 hour (T5) after surgery, respectively. The blood pressure (BP) and the heart rate (HR) at these time points were recorded as well.

RESULTS

The results showed that the patients in the R group had more stable hemodynamics during the surgery and had a significantly lower HR at T2-T5 than those in the S group. The plasma levels of norepinephrine at time points T3-T5 and levels of cortisol at T4-T5 in the R group were significantly lower than those in the S group (P < 0.05).

CONCLUSIONS

The results in the present study indicated that remifentanil could inhibit the stress response in emergent trauma surgery patients more effectively than sufentanil.