title: Anesthetic considerations in HELLP syndrome.
abstract: 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.
  
  
  CONCLUSIONS
  Later, close patient monitoring is recommended for potential development of hemorrhagic complications, disseminated intravascular coagulation (DIC), or eclampsia.
authors.affiliation: Department of Anesthesia, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: del-Rio-Vellosillo
authors.affiliation: Department of Ophthalmology, University Hospital Reina Sofia, Murcia, Spain.|Department of Ophthalmology and Optometry, University School of Medicine, University of Murcia, Murcia, Spain.
authors.forename: J J
authors.initials: JJ
authors.lastname: Garcia-Medina
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000379:methods; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000927:Anticonvulsants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D017359:HELLP Syndrome / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D010956:Plasmapheresis; D011247:Pregnancy
chemical_list: D000305:Adrenal Cortex Hormones; D000927:Anticonvulsants; D000959:Antihypertensive Agents