Department of Anaesthesia, University of Cape Town, South Africa.
Best Pract Res Clin Obstet Gynaecol. 2010 Jun;24(3):401-12. doi: 10.1016/j.bpobgyn.2009.11.005. Epub 2009 Dec 16.
Close co-operation between obstetricians and obstetric anaesthesia providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. Maternal and foetal mortality is unacceptably high, and the practice of obstetric anaesthesia has an important influence on outcome. Well-conducted national audits have identified the contributing factors to anaesthesia-related deaths. Spinal anaesthesia for caesarean section is the method of choice in the absence of contraindications, but is associated with significant morbidity and mortality. Minimum requirements for safe practice are adequate skills, anaesthesia monitors, disposables and drugs and relevant management protocols for each level of care. The importance of current outreach initiatives is emphasised, and educational resources and the available financial sources discussed. The difficulties of efficient procurement of equipment and drugs are outlined. Guiding principles for the practice of analgesia for labour, anaesthesia for caesarean section and the management of obstetric emergencies, where the anaesthetist also has a central role, are suggested.
产科医生和产科麻醉师之间的密切合作对于产妇的安全和舒适至关重要，特别是在资源匮乏的环境中。孕产妇和胎儿的死亡率高得令人无法接受，而产科麻醉的实践对结果有重要影响。精心进行的国家审计已经确定了与麻醉相关死亡的促成因素。在没有禁忌症的情况下，剖宫产时选择椎管内麻醉是首选方法，但与显著的发病率和死亡率相关。安全实践的最低要求是具备足够的技能、麻醉监测器、一次性用品和药物以及每个护理级别的相关管理方案。强调了当前外展倡议的重要性，并讨论了教育资源和可用的资金来源。概述了有效采购设备和药物的困难。提出了指导劳动镇痛、剖宫产麻醉和产科急症管理的原则，在这些情况下，麻醉师也起着核心作用。
