An anaesthetic management of painless octology in patients with perinatal cardiomyopathy

The patient, a 25-year-old woman, 150 cm tall and 42 kg of body mass, was admitted to hospital on April 2, 2018 due to a 14-week suspensionAfter admission to the hospital, The hospital was performed by Refnoll for induction surgery, due to fetal membrane placental incomplete preparation for the intravenous all-hemp emergency surgeryPatients 5 years ago had a caesarean section, 2 months after delivery due to unexplained chest tightness was diagnosed as perinatal cardiomyopathy (peripartum cardioopathy, PPCM), oral digausin, attrelol and furansemiand and other drug treatments, after the gradual discontinuation of teracic and elopemian, the current cardiofunction classification (NY) IIpreoperative electrocardiogram normal, echocardiogram ventricular wall movement generally reduced, two and three tip valve reflux (mild), left chamber contraction and diastolic function reduced, blood score (EF) value of 40%Preoperative patients are anxious, are extremely sensitive to pain and cannot tolerate gynaecological examinationsPrepare first aid drugs such as Western landland, psilocypam and nitropna before anesthesia, and first aid equipment such as anaesthetic machines, laryngoscopes and trachea cathetersThe patient has a heart rate of 120/min, blood pressure of 120/80 mmHg (1 mmHg-0.133 kPa), and suction SpO2 98%Conventional electrocardiogram, open venous pathways, given 2 mg of oxycodone by a small pot, sodium Parisib on 40 mg, after effect intravenous injection relientce on cesteres2 mg, to begin surgerysurgery time 10 min, during surgery patient heart rate 110 to 118 times / min, blood pressure 118 to 124 / 80 to 85 mmHg, anaesthetic mask oxygen absorption SpO2 100%, Ramsay sedation score 2 points, did not see physical movement, did not complain of pain, chest tightness and suffocation and other discomfortDuring the operation, lactic acid linguine 100 ml, bleeding 10 mlPostoperative patients with a visual simulation score (VAS) score of 0, no chest tightness, abstingem and palpitations and other symptoms, in the 2nd day after surgery dischargeddiscussion
PPCM is a type of disease mainly caused by the reduction of heart output to cause insufficient blood flow perfusion and elevated blood vesselpressurepulmonary capillaries, the pathogenesis mechanism is unknown, and the perinatal fatality rate is as high as 50% PPCM diagnosis criteria include: occurring in the last 1 month of pregnancy or 5 months after birth, the patient has no evidence of cardiomyopathy and no obvious resulting in heart failure heart disease during pregnancy, echocardiogram confirmed as left ventricular contractional heart failure It is considered to be a special type of dilated cardiomyopathy, and the treatment is similar to dilated cardiomyopathy PpCM patients have the greatest risk of general anaesthetic for whole hemp drugs to inhibit the inhibition of the heart muscle, which can lead to deterioration of heart function and even disastrous consequences The surgical characteristics of Qinguterine surgery are short time, less bleeding, but strong stimulation, its harmful stimulation mainly comes from the pain caused by the opening of the uterus, the pain caused by the sucking of the uterine wall, as well as the contraction pain after surgery clinical the most commonly used narcotic drug for uterine surgery is propofol However, propofol has no analgesic effect and myocardial inhibition is obvious In this case, patients combined PPCM, burglary anxiety, sensitive to pain, such as analgesic incomplete, pain aggravates the patient's heart burden, easy to cause heart failure; Therefore, the difficulty of anesthesia lies in how to ensure that the patient is painless, no body movement, no contraction pain after surgery, and at the same time, avoid the further inhibition of the heart muscle by anaesthetic drugs oxycodone is currently the only double receptor agonisant, and its receptor agonition agonis is more effective than other opioids for analgesic pain Studies have been studied to use oxycodone compound propofol for painless throes of anaesthetic, and have been found to be effective in reducing the amount of propofol, reducing intraoperative movement, reducing hemodynamic fluctuations, and increasing patients' postoperative analgesic satisfaction Palisadesssabo is a specific cyclooxidase (COX)-2 receptor antagonist, a nonsteroidal anti-inflammatory analgesic that can be used in the treatment of moderate to severe pain, no breathing and cardiovascular inhibition researchers used parisiblyssacompound propofol for painless abortion, and found that analgesics were safe and patient comfort was high In this case, a multi-modal analgesic protocol using a small dose (0.05 mg/kg) of oxycodone compound Parisib sodium minimizes adverse reactions to opioids while ensuring analgesic effect Relying on mitol as a derivative of methermia, it has the advantages of hemodynamic stability, small respiratory inhibition, rapid awakening and wide safety range Some scholars used it (0.3 mg/kg) for painless flow surgery, and found that the patient's respiratory circulation was stable, but the incidence of myoclonus and postoperative nausea and vomiting was high patients given 0.05 mg/kg of stature, during surgery respiratory circulation is stable, calm satisfaction Patients did not have intraoperative myoclonus and postoperative nausea and vomiting, may be related to the amount of relying on cesteres, which also suggests that on the basis of full analgesics, compound small doses of relying on misoestcane can achieve satisfactory sedative effect, while reducing its adverse reactions in summary, PPCM patients do the intrauterine surgery for intravenous full hemp, the option to use a small dose of oxycodone and nonsteroidal anti-inflammatory analgesics for multi-mode full analgesic, on this basis compound small dose of sedative drugs, in the satisfaction of anesthesia effect, can avoid the inhibition of anesthesiology to the heart muscle