General Anesthesia Versus Spinal Anesthesia in Patients of HELLP Syndrome
Condition: HELLP Syndrome
MeSH terms: HELLP Syndrome; Syndrome
Study type: Interventional

Summary: 
      Anesthesia for caesarian section in patients with HELLP syndrome is a challenge. Measures
      should be taken during caesarian delivery to guard against the maternal and fetal
      complications associated with HELLP syndrome.
    

Detailed 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.
    

Intervention name(s): Spinal Anesthesia; General Anesthesia
Intervention type(s): Procedure; Procedure
Intervention description(s): Spinal needle 25G with Quincke's bevel will be used. It will be induced with a total of 10 mg of 0.5% hyperbaric bupivacaine and 20 mcg fentanyl (total volume 2.4 ml) at the L3-4 interspace. The parturient will be returned to the supine position with a left lateral tilt of 15° to facilitate left uterine displacement. The upper sensory block level will be checked 5 min after the spinal injection by assessing the loss of cold sensation from alcohol swabs, to ensure that a Th6 sensory block level has been achieved.; Pre-oxygenation with oxygen 100% via a tight fitting mask rapid sequence technique. Induction is by thiopental (5 mg kg lean body weight) and succinylcholine1.5 mg kg body weight), cricoid pressure should be applied before consciousness is lost and kept in place until confirmation of tracheal intubation with capnography and the cuff of the tracheal tube is inflated. Auscultating the chest helps exclude endobronchial intubation. At this point, surgery may commence.
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment