Bloom Steven L, Spong Catherine Y, Weiner Steven J, Landon Mark B, Rouse Dwight J, Varner Michael W, Moawad Atef H, Caritis Steve N, Harper Margaret, Wapner Ronald J, Sorokin Yoram, Miodovnik Menachem, O'Sullivan Mary J, Sibai Baha, Langer Oded, Gabbe Steven G
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA.
Obstet Gynecol. 2005 Aug;106(2):281-7. doi: 10.1097/01.AOG.0000171105.39219.55.
To quantify anesthesia-related complications associated with cesarean delivery in a well-described, prospectively ascertained cohort from multiple university-based hospitals in the United States and to evaluate whether certain factors would identify women at increased risk for a failed regional anesthetic.
A prospective observational study was conducted of women (n = 37,142) with singleton gestations undergoing cesarean delivery in the centers forming the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Detailed information was collected regarding choice of anesthesia and procedure-related complications, including failed regional anesthetic and maternal death. Potential risk factors for a failed regional anesthetic were analyzed.
Of the women studied, 34,615 (93%) received a regional anesthetic. Few (3.0%) regional procedures failed, and related maternal morbidity was rare. Increased maternal size, higher preoperative risk, rapid decision-to-incision interval, and placement later in labor were all significantly related to an increased risk of a failed regional procedure. Of the general anesthetics, 38% were administered when the decision-to-incision interval was less than 15 minutes. Women deemed at the greatest preoperative risk (American Society of Anesthesiologists score > or = 4) were approximately 7-fold more likely to receive a general anesthetic (odds ratio 6.9, 95% confidence interval 5.83-8.07). There was one maternal death, due to a failed intubation, in which the anesthetic procedure was directly implicated.
Regional techniques have become the preferred method of anesthesia for cesarean delivery. Procedure-related complications are rare and attest to the safety of modern obstetric anesthesia for cesarean delivery in the United States.
在美国多家大学附属医院的一个详细描述且前瞻性确定的队列中,对剖宫产相关的麻醉并发症进行量化,并评估某些因素是否能识别出区域麻醉失败风险增加的女性。
对美国国立儿童健康与人类发展研究所母胎医学单位网络各中心进行剖宫产的单胎妊娠女性(n = 37,142)开展一项前瞻性观察性研究。收集了关于麻醉选择和手术相关并发症的详细信息,包括区域麻醉失败和产妇死亡情况。分析了区域麻醉失败的潜在风险因素。
在研究的女性中,34,615名(93%)接受了区域麻醉。很少有区域麻醉操作失败(3.0%),且相关的产妇发病率很低。产妇体型增大、术前风险较高、决定手术至切开的间隔时间短以及分娩后期进行麻醉均与区域麻醉操作失败风险增加显著相关。在全身麻醉中,38%是在决定手术至切开的间隔时间少于15分钟时实施的。术前被认为风险最高的女性(美国麻醉医师协会评分≥4分)接受全身麻醉的可能性大约高7倍(比值比6.9,95%置信区间5.83 - 8.07)。有1例产妇死亡,原因是插管失败,麻醉操作与之直接相关。
区域麻醉技术已成为剖宫产首选的麻醉方法。与手术相关的并发症很少见,这证明了美国现代剖宫产产科麻醉的安全性。