Farragher Rachel, Datta Sanjay
Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
J Anesth. 2003;17(1):30-41. doi: 10.1007/s005400300005.
The low-dose technique of combined spinal/epidural analgesia is to be welcomed in obstetrics. Its merits include rapid onset of analgesia, with the flexibility of an epidural technique, and high maternal satisfaction. It is a safe and effective technique. Pulse oximetry should be employed when using intrathecal opioids. Commercially available combined-needle devices may make this technique more attractive to users. The role of spinal anesthesia for emergency cesarean section in severe preeclampsia has been reevaluated recently. We consider it a feasible option for those severely preeclamptic women requiring urgent cesarean section who do not have an epidural catheter in place. The choice of anesthetic technique for this patient population should be made on clinical judgment and not on anticipated hemodynamic changes. Spinal anaesthesia for cesarean section is associated with hypotension; however, certain interventions may reduce the incidence and severity of the hypotension. An increase in cardiac output appears to be key in attenuating the hypotensive response to spinal anesthesia. Colloids have exhibited most success in this regard. At our institution, we do not delay spinal anesthesia for urgent cesarean section in order to administer a predetermined volume of fluid; in such cases, we simultaneously administer a fluid preload and spinal anesthesia. Recent studies regarding the use of cell savers for blood conservation in obstetrics are based on small numbers of patients. These studies show great promise, particularly with the modern emphasis on avoiding blood transfusion, which can be massive in this usually young patient population.
腰麻-硬膜外联合镇痛的低剂量技术在产科领域值得推广。其优点包括镇痛起效快，兼具硬膜外技术的灵活性，且产妇满意度高。这是一种安全有效的技术。使用鞘内阿片类药物时应采用脉搏血氧饱和度监测。市售的联合穿刺针装置可能会使该技术对使用者更具吸引力。最近，重度子痫前期患者急诊剖宫产时腰麻的作用已被重新评估。对于那些需要紧急剖宫产且未置入硬膜外导管的重度子痫前期女性，我们认为这是一种可行的选择。对于这类患者群体，麻醉技术的选择应基于临床判断，而非预期的血流动力学变化。剖宫产腰麻会导致低血压；然而，某些干预措施可能会降低低血压的发生率和严重程度。心输出量增加似乎是减轻腰麻低血压反应的关键。在这方面，胶体液最为有效。在我们机构，对于急诊剖宫产，我们不会为了输注预定容量的液体而延迟腰麻；在这种情况下，我们会同时给予液体预负荷和进行腰麻。近期关于产科使用血液回收机进行血液保护的研究基于少量患者。这些研究前景广阔，尤其是在现代强调避免输血的情况下，因为在这个通常较为年轻的患者群体中输血可能量很大。
