HELLP sendromu ve anestezi

HELLP sendromu hemoliz, karaciğer enzimlerinde artış ve platelet sayısında azalma ile karakterize pre-eklampsinin ciddi bir komplikasyonudur. Bu sendromun varlığında maternal ve fetal morbidite ve mortalite artar. Sezaryen sırasındaki cerrahi stres ve kanama riskini azaltmak amacıyla vajinal doğum önerilmektedir. Kontrol edilemeyen hipertansiyon, kanama ve çoklu organ yetmezliği riski yüksek olan bu hastalarda anestezi tekniğine karar vermek kritiktir. HELLP sendromlu hastalarda rejyonal anestezi uygulaması platelet disfonksiyonu ve trombositopeni nedeniyle tartışmalıdır. Bununla birlikte, genel anesteziyle birlikte artan hipertansif yanı t, aspirasyon ve başarısız entübasyon gibi komplikasyonlardan rejyonal anestezi ile kaçınılabildiği gösterilmiştir. HELLP sendromu gelişen gebelerde, erken tanı, yeterli tedavi ve kadın-doğum, anestezi, yenidoğan ve yoğun bakım ekipleri arasındaki iyi iletişim gereklidir.

HELLP syndrome and anesthesia

The HELLP syndrome is a serious complication of pre-eclampsia characterised by haemolysis, elevated liver enzymes and low platelet count. The presence of this syndrome is associated with high incidence of maternal and fetal morbidity and mortality. The route of delivery is usually recommended to be vaginal to reduce the risks of surgical stress and bleeding during cesarean section. The anesthetic technique is critical for these patients with a high risk of uncontrollable hypertension, bleeding and multiple organ failure. Parturients with HELLP syndrome often require general anesthesia for cesarean section delivery. The use of regional anesthesia in HELLP patients is controversial because of thrombocytopenia and platelet dysfunction. However, regional anesthesia has been shown to avoid complications of exacerbated hypertension, aspiration, and failed intubation attributable to general anesthesia in this population. In the management of pregnant women complicated with HELLP syndrome, early diagnosis, adequate therapy and good communication among the obstetric, anesthesia, neonatology and critical care teams, are necessary.

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