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A suggested plan for the perioperative anesthetic management of elective cesarean-hysterectomy due to placenta accreta
Abstract Number: F-14
Abstract Type: Case Report/Case Series
Placenta accreta is the most common indication for peripartum hysterectomy and a potentially life-threatening obstetric condition, requiring a coordinated multidisciplinary approach. The perioperative role of the anesthesiologist is extensive; however, the current literature lacks specific guidance for the anesthesiologist. Evidence-based guidelines intend to improve patient care and health outcomes by promoting interventions of proved benefit. We aimed to produce perioperative anesthesia guidance for our tertiary obstetric center of excellence, with a vision to promote a standardized approach to the elective cesarean-hysterectomies due to placenta accreta.
The current literature was examined for the benefits and risks of regional and general anesthesia in this setting. Furthermore, the evidence for interventions to minimize blood loss (pharmacological and non-pharmacological); replacement of circulating volume (including crystalloid, colloid, blood product and autologous cell salvaged blood); optimization of analgesia (including pre-medication); and provision of aspiration prophylaxis was searched. In addition, local institutional practices and opinions were collated. The evidence was reviewed by collaboration within our department, and a consensus achieved.
Figure. 1 depicts step by step the suggested perioperative anesthesia management, with the rationale or evidence for each step.
There is limited guidance on the perioperative anesthesia management for elective cesarean-hysterectomies for placenta accreta in the current literature. Our institution has developed a suggested evidence-based guidance for the management of these cases to conform to a more uniformed and standardized practice. This provides an evidence-based algorithm on the provision of optimal intra and post-operative analgesia, replacement of circulating volume and maintenance of hemodynamic stability with fluid therapy and blood products, promotion of hemostasis with pharmacological therapy and blood products, and minimizing the risk of aspiration. Furthermore, at our institution, where 12-18 such cases are performed each year, this standardized approach will allow audit of our technique in the future.
1) BMJ 1999;318:527-30