General Anesthesia Versus Spinal Anesthesia in Patients of HELLP Syndrome
Description:
The choice of anesthesia for caesarian section in parturient with HELLP syndrome is a debate.
The low platelet count, associated with HELLP syndrome, has often favored the choice of
general anesthesia for the caesarian delivery of these parturient. However, general
anesthesia in such cases; is not a risk-free approach. General anesthesia is associated with
increased risk of difficult airways, stress response to intubation and aspiration. It is also
thought to have an effect on the fetus with the potential placental transfer of inhalational
anesthetics prior to delivery.
Regional anesthesia is widely regarded as a means of providing analgesia for cesarean
section.it also avoids the above-mentioned risks associated with general anesthesia. Regional
anesthesia for caesarian section in patients with HELLP syndrome has been used by some
researchers in many centers with encouraging results.
The lowest platelet count at which one can safely administer neuraxial anesthesia for labour
and delivery is controversial. Published studies are few and sample sizes small.
Criteria developed at the University of Mississippi, as of 2006: "For a patient to merit a
diagnosis of HELLP syndrome, class 1 requires severe thrombocytopenia (platelets ≤50,000/μl),
evidence of hepatic dysfunction (AST and/or ALT ≥70 IU/l), and evidence suggestive of
hemolysis (total serum LDH ≥600 IU/l); class 2 requires similar criteria except
thrombocytopenia is moderate (>50,000 to ≤100,000/μl); and class 3 includes patients with
mild thrombocytopenia (platelets >100,000 but ≤150,000/μl), mild hepatic dysfunction (AST
and/or ALT ≥40 IU/l), and hemolysis (total serum LDH ≥600 IU/L).
The researchers chose to investigate class 2 HELLP syndrome as class 3 proved to be safe with
regional anesthesia while class 1 seemed to be high risk and un-ethical to do spinal
anesthesia with very low platelets count with lack of any evidence to its safety.
Condition:
HELLP Syndrome
Treatment:
Spinal Anesthesia
Start Date:
April 15, 2017
Sponsor:
Assiut University
For More Information:
https://clinicaltrials.gov/show/NCT03111446