Intensive Care Unit and Anesthesia Management

Dr. Hafize Yasemin Dayıcan1
Prof. Dr. İlkay Baran Akkuş2

1Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital,Ankara, Türkiye
2Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital,Ankara, Türkiye

ABSTRACT

Placenta accreta spectrum (PAS) is a complex and potentially life-threatening condition characterized by ab- normal placental adherence or invasion into the uterine myometrium. Over recent decades, the incidence of PAS has significantly increased, making it a major cause of obstetric hemorrhage and severe maternal morbid- ity and mortality worldwide. The management of PAS necessitates a multidisciplinary approach to optimize maternal outcomes, particularly during the perioperative period.

Effective anesthetic management in PAS involves meticulous preoperative evaluation, including a compre- hensive assessment and collaboration with specialized PAS centers. Key considerations in anesthetic manage- ment include the strategic timing and location of delivery, integration of interventional radiology techniques, and application of tailored anesthetic strategies to navigate the complexities of the surgical approach. Anes- thesiologists must be prepared for substantial hemodynamic challenges, such as massive hemorrhage, and should implement robust strategies for hemorrhage control, fluid management, and point-of-care monitoring.

The choice of anesthetic technique—whether neuraxial, general, or a combination—should be individualized based on the patient’s condition, the anticipated complexity of the surgery, and the needs for intraoperative and postoperative analgesia. Collaboration with surgical teams and interventional radiologists is crucial for minimizing blood loss and enhancing surgical outcomes. Postoperative care must emphasize vigilant monitor- ing for complications and adequate analgesia to support recovery.

This chapter will review current best practices and evidence-based approaches for anesthetic management in PAS, focusing on the importance of a comprehensive and coordinated care plan. By addressing preoperative preparation, surgical strategy, and postoperative care, the chapter aims to ensure the safety and well-being of both mother and infant in the context of PAS.

Keywords: Plasenta accreata spectrum; Preanesthetic assessment; Anesthetic management; Postoperative care; Peripartum hemorrhage; Intensive care unit

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