Ravindra G L, Madamangalam Abhinava S, Seetharamaiah Shwetha
Janani Anaesthesia and Critical Care Services, Shimoga, Karnataka, India.
Geisinger Medical Center, Danville, PA, USA.
Indian J Anaesth. 2018 Sep;62(9):710-716. doi: 10.4103/ija.IJA_463_18.
Anaesthesia for pregnant patients presenting for non-obstetric surgery needs a thorough understanding of the physiological changes and altered pharmacokinetics of pregnancy. Considering the effects of surgery and anaesthesia on the foetus, only essential and emergency surgeries are performed during pregnancy. Surgical procedures in second trimester have the advantage of better foetal outcome. The primary concerns of maternal and foetal safety are achieved by a focused multidisciplinary team-based approach with respect to the surgical condition. Meticulous attention to preoperative patient counselling, airway management, haemodynamic stability, and thromboprophylaxis are the key factors in anaesthetic management. Choice of anaesthesia or anaesthetic drugs has minimal impact on the foetus provided utero-placental perfusion and uterine relaxation are maintained. Foetal monitoring when feasible and when done by a trained person enables to diagnose and treat the factors responsible for foetal heart rate variability. Anaesthetic technique needs to be modified according to the type of surgery.
为接受非产科手术的孕妇实施麻醉，需要全面了解孕期的生理变化和改变的药代动力学。考虑到手术和麻醉对胎儿的影响，孕期仅进行必要和急诊手术。孕中期进行手术操作对胎儿结局更有利。通过针对手术情况采取专注的多学科团队方法，可实现对母体和胎儿安全的主要关注。精心关注术前患者咨询、气道管理、血流动力学稳定性和血栓预防是麻醉管理的关键因素。只要维持子宫胎盘灌注和子宫松弛，麻醉方式或麻醉药物的选择对胎儿影响极小。可行时且由经过培训的人员进行胎儿监测，有助于诊断和治疗导致胎儿心率变异的因素。麻醉技术需要根据手术类型进行调整。
