Ring Laurence, Landau Ruth, Delgado Carlos
Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA USA.
Curr Anesthesiol Rep. 2021;11(1):18-27. doi: 10.1007/s40140-021-00437-6. Epub 2021 Feb 24.
The use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this review, we will discuss clinical scenarios and risk factors associated with general anesthesia for cesarean delivery and address reasons why anesthesiologists should apply strategies to minimize its use.
Unnecessary general anesthesia for cesarean delivery is associated with maternal complications, including serious anesthesia-related complications, surgical site infection, and venous thromboembolic events. Racial and socioeconomic disparities and low-resource settings are major contributing factors in the use of general anesthesia for cesarean delivery, with both maternal and perinatal mortality increasing when general anesthesia is provided. In addition, more significant maternal pain and higher rates of postpartum depression requiring hospitalization are associated with general anesthesia for cesarean delivery.
Rates of general anesthesia for cesarean delivery have overall decreased, and while general anesthesia no longer is a contributing factor to anesthesia-related maternal deaths, further opportunities to reduce its use should be emphasized. Raising awareness in identifying situations and patients at risk to help avoid unnecessary general anesthesia remains crucial.
在过去几十年中，由于神经轴技术的广泛应用以及人们认识到即使在紧急情况下也可实施神经轴麻醉，剖宫产全身麻醉的使用有所减少。事实上，剖宫产全身麻醉的作用已被重新审视，因为尽管近期有便于气管插管的设备和临床算法，可指导麻醉医生应对具有挑战性的情况，但分娩时全身麻醉对母亲和新生儿的风险及并发症仍然很大。在本综述中，我们将讨论与剖宫产全身麻醉相关的临床情况和风险因素，并阐述麻醉医生应采取策略尽量减少其使用的原因。
剖宫产不必要的全身麻醉与母亲并发症相关，包括严重的麻醉相关并发症、手术部位感染和静脉血栓栓塞事件。种族和社会经济差异以及资源匮乏环境是剖宫产使用全身麻醉的主要促成因素，提供全身麻醉时母亲和围产期死亡率均会增加。此外，剖宫产全身麻醉还与母亲更严重的疼痛以及更高的产后抑郁症住院率相关。
剖宫产全身麻醉的发生率总体上有所下降，虽然全身麻醉不再是导致麻醉相关母亲死亡的因素，但仍应强调进一步减少其使用的机会。提高对识别有风险的情况和患者的认识以避免不必要的全身麻醉仍然至关重要。
