From the Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Anesth Analg. 2020 Jul;131(1):307-316. doi: 10.1213/ANE.0000000000004714.
This article summarizes the Gerard W. Ostheimer Lecture given at the 2019 Society for Obstetric Anesthesia and Perinatology annual meeting. The article summarizes key articles published in 2018 that were presented in the 2019 Ostheimer Lecture, with a focus on maternal mortality, maternal complications, analgesic and anesthetic management of vaginal and cesarean deliveries, postpartum care, and the impact of anesthesia on maternal outcomes. The reviewed literature highlights many opportunities for anesthesiologists to impact maternal care and outcomes. The major themes presented in this manuscript are maternal mortality including amniotic fluid and cardiac arrest; postpartum hemorrhage; venous thromboembolism; management of spinal-induced hypotension; postpartum care including opioid use, postcesarean analgesia, and postpartum depression. A proposed list of action items and research topics based on the literature from 2018 is also presented. Specifically, anesthesiologists should use prophylactic vasopressor infusions during elective cesarean delivery; use a structured algorithm to diagnose pulmonary embolus, and reevaluate the use of D-dimer measurements; target postpartum opioid analgesia and prescribing; use multimodal postcesarean delivery analgesia, preferably with neuraxial hydrophilic opioids; and study any association between labor analgesia on postpartum depression.
本文总结了 2019 年产科麻醉与围产医学学会年会上的 Gerard W. Ostheimer 讲座。本文总结了在 2019 年 Ostheimer 讲座中呈现的 2018 年发表的重点文章，重点关注孕产妇死亡率、孕产妇并发症、阴道分娩和剖宫产的镇痛和麻醉管理、产后护理以及麻醉对产妇结局的影响。综述文献强调了麻醉医师在影响孕产妇护理和结局方面有许多机会。本文提出的主要主题包括孕产妇死亡率（包括羊水和心脏骤停）、产后出血、静脉血栓栓塞、脊髓诱导性低血压的管理、包括阿片类药物使用、剖宫产术后镇痛和产后抑郁在内的产后护理。还根据 2018 年的文献提出了一系列行动项目和研究主题。具体而言，麻醉医师应在择期剖宫产时使用预防性血管加压素输注；使用结构化算法诊断肺栓塞，并重新评估 D-二聚体测量的使用；将阿片类药物用于产后镇痛，并进行处方管理；使用多模式剖宫产术后镇痛，最好使用亲水性阿片类药物；研究分娩镇痛与产后抑郁之间的任何关联。
