Hamza J, Poupard M, Jorrot J C, Toubas F, Saint-Maurice C
DAR, Hôpital St-Vincent-de-Paul, Paris.
Cah Anesthesiol. 1994;42(6):739-49.
Emergency cesarean section is sometimes required for acute fetal distress but also for some maternal vital emergencies. In spite of its maternal (Mendelson's syndrome, difficult intubation) and fetal (neonatal depression) risks, general anaesthesia was classically used. The arguments in favor of regional anaesthesia techniques for emergency cesarean section and the respective advantages of spinal and epidural anaesthesia are developed in this text. The already functioning epidural catheter can be used to rapidly convert analgesia for labor to anaesthesia for cesarean section: this situation is probably the simplest to manage but requires that parturients at risk for cesarean section were recognized in early labor, especially all the parturients with a suspected difficult airway. In case of patchy or unilateral analgesia, it is particularly important to resite the catheter to avoid the need for emergency general anaesthesia to solve an inadequate epidural anaesthesia for cesarean section. Spinal anaesthesia is the technique of choice for its rapidity of action but its hemodynamic risks need a prior careful evaluation of maternal hemodynamics. General anaesthesia will be always indispensable in some cases; therefore, every anaesthetist should maintain sufficient experience and skills in the management of some of its complications, especially intubation difficulties.
紧急剖宫产有时是因急性胎儿窘迫所需，但也用于一些产妇的重要紧急情况。尽管存在产妇风险（门德尔松综合征、插管困难）和胎儿风险（新生儿抑制），但传统上仍使用全身麻醉。本文阐述了支持在紧急剖宫产中采用区域麻醉技术以及腰麻和硬膜外麻醉各自优势的观点。已置入的硬膜外导管可用于迅速将分娩镇痛转换为剖宫产麻醉：这种情况可能是最易于处理的，但要求在分娩早期识别有剖宫产风险的产妇，尤其是所有疑似气道困难的产妇。在出现片状或单侧镇痛的情况下，重新放置导管尤为重要，以避免因剖宫产硬膜外麻醉不足而需要紧急全身麻醉。腰麻因其起效迅速是首选技术，但其血流动力学风险需要事先仔细评估产妇的血流动力学状况。在某些情况下，全身麻醉将始终不可或缺；因此，每位麻醉医生都应在处理其一些并发症，尤其是插管困难方面保持足够的经验和技能。
