Arndt M, Benad G
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Medizinischen Fakultät, Universität, Rostock.
Anaesthesiol Reanim. 1994;19(4):88-94.
In obstetric anaesthesia, general anaesthesia combined with endotracheal intubation, spinal anaesthesia and peridural anaesthesia is used. The main risks of general anaesthesia are: difficult intubation, aspiration of acid gastric content in non-fasting patients, depression of the fetus with narcotics and the occurrence of awareness of the mother. The main dangers of spinal anaesthesia are: hypotension of the mother leading to reduced utero-placentar blood flow due to sympathetic block, post-spinal headache and vomiting. The specific risks of peridural anaesthesia are: maternal hypotension, the possibility of inadvertent intravenous injection of local anaesthetics leading to cardiac and cerebral intoxication, inadvertent intrathecal application of local anaesthetics followed by total spinal block which requires reanimation and inadvertent dura perforation followed by long-lasting headache. Most anaesthesia-related maternal deaths by far occur during Caesarean section performed under general anaesthesia, but at present there is no clear evidence that the anaesthetic risk of spinal or peridural anaesthesia, on the one hand, is lower than that one of general anaesthesia, on the other.
在产科麻醉中,会使用全身麻醉联合气管插管、脊髓麻醉和硬膜外麻醉。全身麻醉的主要风险有:插管困难、非禁食患者胃酸胃内容物误吸、麻醉药品导致胎儿抑制以及产妇术中知晓的发生。脊髓麻醉的主要危险有:由于交感神经阻滞导致产妇低血压,进而引起子宫胎盘血流减少、脊麻后头痛和呕吐。硬膜外麻醉的特定风险有:产妇低血压、意外静脉注射局部麻醉药导致心脏和脑部中毒的可能性、意外鞘内应用局部麻醉药继而发生全脊髓阻滞(这需要复苏)以及意外硬膜穿孔继而导致长期头痛。迄今为止,大多数与麻醉相关的产妇死亡发生在全身麻醉下进行的剖宫产手术期间,但目前尚无明确证据表明,一方面,脊髓或硬膜外麻醉的麻醉风险低于全身麻醉,另一方面,也无明确证据表明其高于全身麻醉。