Department of Anaesthesia, West Middlesex University Hospital, London, UK.
Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.
Anaesthesia. 2022 Dec;77(12):1416-1429. doi: 10.1111/anae.15839. Epub 2022 Sep 12.
We conducted a narrative review in six areas of obstetric emergencies: category-1 caesarean section; difficult and failed airway; massive obstetric haemorrhage; hypertensive crisis; emergencies related to neuraxial anaesthesia; and maternal cardiac arrest. These areas represent significant research published within the last five years, with emphasis on large multicentre randomised trials, national or international practice guidelines and recommendations from major professional societies. Key topics discussed: prevention and management of failed neuraxial technique; role of high-flow nasal oxygenation and choice of neuromuscular drug in obstetric patients; prevention of accidental awareness during general anaesthesia; management of the difficult and failed obstetric airway; current perspectives on the use of tranexamic acid, fibrinogen concentrate and cell salvage; guidance on neuraxial placement in a thrombocytopenic obstetric patient; management of neuraxial drug errors, local anaesthetic systemic toxicity and unusually prolonged neuraxial block regression; and extracorporeal membrane oxygenation use in maternal cardiac arrest.
1 类剖宫产术；困难和失败的气道；大出血；高血压危象；与椎管内麻醉相关的紧急情况；以及产妇心搏骤停。这些领域代表了过去五年内发表的重要研究，重点是大型多中心随机试验、国家或国际实践指南以及主要专业协会的建议。讨论的主要议题包括：失败的椎管内技术的预防和管理；高流量鼻氧和肌肉松弛药物在产科患者中的选择；预防全身麻醉期间的意外意识；困难和失败的产科气道的管理；氨甲环酸、纤维蛋白原浓缩物和细胞回收的使用的最新观点；在血小板减少的产科患者中进行椎管内放置的指南；椎管内药物错误、局部麻醉全身毒性和异常延长的椎管内阻滞消退的管理；以及体外膜肺氧合在产妇心搏骤停中的应用。
