Anesthetic considerations in HELLP syndrome

Background HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is an obstetric complication with heterogonous presentation and multisystemic involvement. It is characterized by microangiopathic hemolytic anemia, elevated liver enzymes by intravascular breakdown of fibrin in hepatic sin...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2016-02, Vol.60 (2), p.144-157
Main Authors: del-Rio-Vellosillo, M., Garcia-Medina, J. J.
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Anesthesia
Anesthesia, Conduction - methods
Anesthesia, General
Anesthesia, Obstetrical - methods
Anticonvulsants - therapeutic use
Antihypertensive Agents - therapeutic use
Enzymes
Female
Fluid Therapy
HELLP Syndrome - diagnosis
HELLP Syndrome - physiopathology
Humans
Intubation
Ostomy
Patients
Plasmapheresis
Pregnancy
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Summary:Background HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is an obstetric complication with heterogonous presentation and multisystemic involvement. It is characterized by microangiopathic hemolytic anemia, elevated liver enzymes by intravascular breakdown of fibrin in hepatic sinusoids and reduction of platelet circulation by its increased consumption. Methods In terms of these patients' anesthetic management, it is essential to consider some details: (1) effective, safe perioperative management by a multidisciplinary approach, and quick, good communication among clinical specialists to achieve correct patient management; (2) neuroaxial block, particularly spinal anesthesia, is the first choice to do the cesarean if there is only moderate, but not progressive thrombocytopenia; (3) if a general anesthesia is required, it is necessary to control the response to stress produced by intubation, especially in patients with either severe high blood pressure or neurological signs, or to prevent major cerebral complications; (4) invasive techniques, e.g., as tracheostomy, arterial, and deep‐vein canalization, should be considered; (5) if contraindication for neuroaxial anesthesia exists, rapid sequence intubation with general anesthesia should be regarded as an emergency in patients with full stomach; (6) increased risk of difficult airways should be taken into account. Results Optimal patient management can be chosen after considering the risks and benefits of each anesthetic technique, and based on good knowledge of these patients' pathophysiological conditions. Conclusion Later, close patient monitoring is recommended for potential development of hemorrhagic complications, disseminated intravascular coagulation (DIC), or eclampsia.
ISSN:0001-5172
1399-6576
DOI:10.1111/aas.12639