Haque M F, Sen S, Meftahuzzaman S M, Haque M M
Mymensingh Medical College, Mymensingh, Bangladesh.
Mymensingh Med J. 2008 Jul;17(2):221-6.
Caesarean Section is one of the most common of all surgical procedures. Common indications for caesarean section may include foetal distress, Cephalopelvic disproportion and failure of labour to progress. Both regional and general anesthesia may be employed for caesarean section. Each is relatively safe and they have their own advantages and disadvantages. Actual decision to adopt one technique over another depends on maternal and foetal status and skill and ability of the anesthesiologist to tackle the situation with the aim of patient and baby safely. Among these, many of the cases come to the hospital as emergency basis. The Anesthesiologists have to face the challenge in providing anesthesia for emergency caesarean section, being the last member in the perinatal team. The challenge faces the risks in involvement of maternal changes in pregnancy, presence of foetal distress and various anesthetic complications arising in perioperative period. Still now anesthetic mishaps are considered as the sixth most frequent cause of maternal mortality. The use of regional Anesthesia reduced the number of deaths at about 80% but deaths involving general anesthesia has not decreased and the incidence is 17 times more than the regional anesthesia. Most of the deaths or complications are related to the airway management (also failed intubation). Better skill and knowledge in physiology, pharmacology and use of modern Anesthetic technique is essential to face the problems.
剖宫产是所有外科手术中最常见的手术之一。剖宫产的常见指征可能包括胎儿窘迫、头盆不称和产程进展失败。剖宫产可采用区域麻醉和全身麻醉。两者相对安全，且各有优缺点。实际选择采用哪种技术取决于产妇和胎儿的状况以及麻醉医生应对情况的技能和能力，目标是确保产妇和婴儿的安全。其中，许多病例是以急诊形式入院的。麻醉医生作为围产期团队的最后一员，必须面对为急诊剖宫产提供麻醉的挑战。这一挑战涉及到妊娠期间产妇的变化、胎儿窘迫的存在以及围手术期出现的各种麻醉并发症等风险。目前，麻醉失误仍被认为是孕产妇死亡的第六大常见原因。使用区域麻醉可使死亡人数减少约80%，但全身麻醉导致的死亡人数并未下降，其发生率比区域麻醉高出17倍。大多数死亡或并发症与气道管理（也包括插管失败）有关。具备更好的生理学、药理学技能和知识以及使用现代麻醉技术对于应对这些问题至关重要。
