From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Anesthesiology & Critical Care & Pain, Sourasky Medical Center, Tel Aviv, Israel.
Anesth Analg. 2019 Aug;129(2):458-474. doi: 10.1213/ANE.0000000000004195.
The majority of women undergoing cesarean delivery in the United States receive neuraxial morphine, the most effective form of postoperative analgesia for this surgery. Current American Society of Anesthesiologists (ASA) and American Society of Regional Anesthesia and Pain Medicine (ASRA) recommend respiratory monitoring standards following neuraxial morphine administration in the general surgical population that may be too frequent and intensive when applied to the healthy obstetric population receiving a single dose of neuraxial morphine at the time of surgery. There is limited evidence to support or guide the optimal modality, frequency, and duration of respiratory monitoring in the postoperative cesarean delivery patient receiving a single dose of neuraxial morphine. Consistent with the mission of the Society for Obstetric Anesthesia and Perinatology (SOAP) to improve outcomes in pregnancy for women and neonates, the purpose of this consensus statement is to encourage the use of this highly effective analgesic technique while promoting safe practice and patient-centered care. The document aims to reduce unnecessary interruptions from respiratory monitoring in healthy mothers while focusing vigilance on monitoring in those women at highest risk for respiratory depression following neuraxial morphine administration. This consensus statement promotes the use of low-dose neuraxial morphine and multimodal analgesia after cesarean delivery, gives perspective on the safety of this analgesic technique in healthy women, and promotes patient risk stratification and perioperative risk assessment to determine and adjust the intensity, frequency, and duration of respiratory monitoring.
在美国,大多数接受剖宫产的女性都会接受椎管内吗啡,这是该手术最有效的术后镇痛形式。目前,美国麻醉医师学会(ASA)和美国区域麻醉与疼痛医学学会(ASRA)建议,在普通外科人群中,椎管内吗啡给药后应遵循呼吸监测标准,但当应用于接受单次椎管内吗啡剂量的健康产科人群时,这些标准可能过于频繁和密集。目前,支持或指导单次接受椎管内吗啡的剖宫产术后患者进行最佳呼吸监测模式、频率和持续时间的证据有限。与产科麻醉与围产医学学会(SOAP)改善妊娠期间女性和新生儿结局的使命一致,本共识的目的是鼓励使用这种高效的镇痛技术,同时促进安全实践和以患者为中心的护理。本文件旨在减少健康母亲因呼吸监测而产生的不必要干扰,同时关注那些在接受椎管内吗啡给药后发生呼吸抑制风险最高的女性的监测。本共识促进了剖宫产术后使用低剂量椎管内吗啡和多模式镇痛,从健康女性的角度看待这种镇痛技术的安全性,并促进了患者风险分层和围手术期风险评估,以确定和调整呼吸监测的强度、频率和持续时间。