Helmer P, Skazel T, Wenk M, von Kaisenberg C, Abou-Dakn M, Papsdorf M, Abu Hmeidan F, Kehl S, Meybohm P, Kranke Peter
Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Florence-Nightingale Krankenhaus, Düsseldorf, Deutschland.
Anaesthesist. 2021 Dec;70(12):1031-1039. doi: 10.1007/s00101-021-01024-4. Epub 2021 Sep 6.
The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.
关于“足月阴道分娩”的新S3指南以及同样于2020年发布的剖宫产指南的出版,为促进产科循证医学又迈出了新的步伐,尽管分娩期间新生儿监测的确切配置,尤其是这一点,仍是当前讨论的主题。参与编写S3指南的各方行动者和专业学会在分娩医疗监督的多专业性方面也有很好的体现。从麻醉学角度来看,重要的是神经轴阻滞操作仍是产科镇痛的金标准。瑞芬太尼自控镇痛是一种可供选择的方法,例如在存在实施神经轴阻滞方法的禁忌证时,如果在当前情况下合适(1:1支持和适当监测),它能实现可靠的镇痛。在顺产过程中,严格的禁食规则有所放宽。总体而言,这些指南强调了孕妇自主决定权和自我控制的重要性,并将母婴的安全与健康放在首位;然而,这前提是孕妇充分了解神经轴阻滞镇痛的价值。为此,发起超越通常仅由助产士组织的面向父母的信息交流会的信息建议似乎很重要。