Girard T, Brugger S, Hösli I
Anästhesiologie, Universitätssital Basel, Spitalstr. 21, 4031, Basel, Schweiz,
Anaesthesist. 2013 Dec;62(12):963-72. doi: 10.1007/s00101-013-2235-1.
The risk profile of patients in obstetric anesthesia has substantially changed. Even more so than other disciplines, obstetric anesthesia is therefore in the true sense of the word dependent on the close coordination of all concerned and a good interdisciplinary cooperation.
This article explains the important anesthesiological risks connected with parturition and presents the corresponding concepts for prevention, diagnosis and management of peripartum complications.
The increase in the number of high risk pregnancies, which are mostly due to an increase in obesity, require clearly defined guidelines and interdisciplinary concepts which are described and discussed in this article. The neuraxial block is still the most effective procedure for treatment of birth pain and offers a promising new method with the programmed intermittent epidural boluses presented in this article. Finally, the German speaking countries Germany, Austria and Switzerland have developed a treatment algorithm for the management of postpartum hemorrhage which is presented here.
The anesthesiological components of a risk pregnancy must be recognized early and include obesity, preeclampsia and drug-induced coagulopathy. Epidural analgesia is the most effective analgesic procedure in obstetrics. Patient-controlled remifentanil analgesia currently represents the best alternative in cases of contraindications for a neuraxial procedure.
In risk situations, such as pre(eclempsia), emergency cesarean section, massive blood loss or other peripartum emergency situations, optimal interdisciplinary cooperation between midwives, obstetricians and anesthetists is required. However, not only emergency situations require a good interdisciplinary cooperation. Just as important is the cooperation to recognize risk pregnancies and a timely joint planning of the approaching birth.
产科麻醉患者的风险状况已发生了重大变化。因此，与其他学科相比，产科麻醉在真正意义上更依赖于所有相关人员的密切协作以及良好的多学科合作。
本文阐述了与分娩相关的重要麻醉风险，并介绍了围产期并发症的预防、诊断和管理的相应概念。
高危妊娠数量的增加主要归因于肥胖人数的增多，这需要明确的指导方针和多学科概念，本文对此进行了描述和讨论。神经阻滞仍然是治疗分娩疼痛最有效的方法，本文介绍的程序化间歇性硬膜外推注提供了一种有前景的新方法。最后，德语国家德国、奥地利和瑞士制定了产后出血管理的治疗算法，在此予以介绍。
高危妊娠的麻醉相关因素必须尽早识别，包括肥胖、先兆子痫和药物性凝血病。硬膜外镇痛是产科最有效的镇痛方法。在神经阻滞禁忌的情况下，患者自控瑞芬太尼镇痛目前是最佳选择。
在诸如先兆子痫、急诊剖宫产、大量失血或其他围产期紧急情况等风险状况下，助产士、产科医生和麻醉医生之间需要进行最佳的多学科合作。然而，不仅紧急情况需要良好的多学科合作。识别高危妊娠并及时共同规划即将到来的分娩同样重要。
