Plaat Felicity, Wray Sarah
Department of Anaesthesia, 5th Floor, Hammersmith House, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
Best Pract Res Clin Obstet Gynaecol. 2008 Oct;22(5):917-35. doi: 10.1016/j.bpobgyn.2008.06.006. Epub 2008 Aug 23.
The anaesthetist plays a key role in the management of high-risk pregnancies, and must be a member of the multidisciplinary team that is required to care for the critically ill obstetric patient. Anaesthetists are trained in advanced life support and resuscitation. They are experienced in the management of the critically ill, and provide anaesthesia, sedation and pain management. The obstetric anaesthetist should undertake education of medical and midwifery staff in the early recognition, monitoring and treatment of the sick mother, resuscitation training, running 'skills drills' for emergency simulations, risk management and audit of maternal morbidity on the labour ward. To date, there is little evidence to inform the anaesthetic management of the critically ill obstetric patient; most recommendations and guidelines are based on the management of non-obstetric, critically ill patients. Management must be adapted to encompass the physiological changes of pregnancy. Evidence-based guidelines on management of the critically ill woman with specific obstetric conditions are also lacking.
麻醉医生在高危妊娠的管理中发挥着关键作用，并且必须是负责照料重症产科患者的多学科团队的一员。麻醉医生接受过高级生命支持和复苏培训。他们在重症患者管理方面经验丰富，并提供麻醉、镇静和疼痛管理。产科麻醉医生应开展针对医护人员的教育，内容包括患病母亲的早期识别、监测和治疗、复苏培训、进行应急模拟的“技能演练”、风险管理以及对产房孕产妇发病率的审核。迄今为止，几乎没有证据可用于指导重症产科患者的麻醉管理；大多数建议和指南是基于非产科重症患者的管理制定的。管理必须进行调整以适应妊娠的生理变化。针对患有特定产科疾病的重症女性的循证管理指南也很缺乏。
