응급 자궁적출술시 마취관리

Emergency hysterectomy has been accepted as a life-saving procedure for patients with bleeding at the time of cesarean section. This study analyzed the patients of emergency obstetric hysterectomy performed at CHA hospital for 4 years from January 1990 to December 1993. During the 4 year study there were 32,090 deliveries, 8021 of which were cesarean sections. 42 emergency obstetric hysterectomies were performed; there were 36 cases after normal spontaneous vaginal delivery and 6 cases after cesarean section. The results of this study were as follows ; 1) 42 patients were evaluated, ranging in age from 23 years to 41 years and averaging 32 years. 2) The most common indications for cesarean hysterectomy were atony (35.7%) and placenta previa and accreta (35.7%). 3) Five patients received continuous epidural anesthesia and three of them with initially satisfactory epidural anesthesia required intraoperative induction of general anesthesia. Other patients received general anesthesia. Mean anesthetic time was 2 hours and 37 minutes. 4) Mean units transfused during operation were 11.1 pints. Mean preoperative hemoglobin and hematocrit were 10.3 g/dl and 31.9%. Mean postoperative hemoglobin and hematocrit were 10.5 g/dl and 33.1%. 5) Complications were found in 6 cases, including bladder injury, bleeding at the vaginal cuff area, pulmonary edema and paralytic ileus. Average hospital stay was 8.8 days.