Dennis Alicia T, Xin Annie, Farber Michaela K
Division of Obstetric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Critical Care and Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Parkville, Victoria, Australia; School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Department of Anaesthesia, Pain and Perioperative Medicine, Joan Kirner Women's and Children's Sunshine Hospital, Western Health, St. Albans, Victoria, Australia.
Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; and Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Anesthesiology. 2025 Feb 1;142(2):378-402. doi: 10.1097/ALN.0000000000005296. Epub 2025 Jan 14.
Preeclampsia is a common condition of pregnancy characterized by hypertension complicated by cerebral, cardiac, hepatic, renal, hematologic, and placental dysfunction. Patients with preeclampsia frequently undergo cesarean delivery, the most common major surgical procedure in the world. They represent a high-risk perioperative cohort suffering significant preventable morbidity and mortality. This review focuses on the anesthesiologist's role, through a perioperative lens, in reducing maternal complications through management of hypertension and strategies for preserving the function of the brain, heart, liver, kidney, hematologic and coagulation systems, and placenta in patients with preeclampsia undergoing cesarean delivery. Preeclampsia-specific resuscitation, individualized fluid administration, safe neuraxial and general anesthesia, and management of intraoperative bleeding are discussed along with strategies for postoperative analgesia, thromboprophylaxis, and antihypertensive agents in patients who breastfeed. This review discusses recently recognized postoperative deterioration in maternal mental health, the possibility of myocardial injury after cesarean delivery, and the need for long-term cardiometabolic follow-up.
子痫前期是一种常见的妊娠疾病，其特征为高血压，并伴有脑、心脏、肝脏、肾脏、血液及胎盘功能障碍。子痫前期患者常接受剖宫产，这是全球最常见的大型外科手术。他们属于围手术期高危人群，面临着显著的可预防的发病率和死亡率。本综述通过围手术期视角，重点探讨麻醉医生在子痫前期患者剖宫产手术中所扮演的角色，即通过控制高血压以及采取策略来保护脑、心脏、肝脏、肾脏、血液及凝血系统以及胎盘的功能，从而降低孕产妇并发症。文中讨论了子痫前期特异性复苏、个体化液体管理、安全的椎管内麻醉和全身麻醉以及术中出血的处理，还涉及了母乳喂养患者的术后镇痛、血栓预防和抗高血压药物策略。本综述还讨论了近期发现的孕产妇术后心理健康恶化情况、剖宫产术后心肌损伤的可能性以及长期心脏代谢随访的必要性。
