Hamza J
Département d'Anesthésie-Réanimation, Hôpital St-Vincent-de-Paul, Paris.
Cah Anesthesiol. 1994;42(1):47-59.
Anaesthesia for fetal distress is usually indicated for emergency caesarean section. General anaesthesia, which is the classical technique in these cases, remains the leading cause of anaesthesia-related maternal mortality. Difficult intubation and Mendelson's syndrome are mostly responsible for these fatalities. Nevertheless there are several answers to this problem. A better evaluation of the patient's problems based upon a preanaesthetic outpatient visit during the last term of pregnancy allows a more rational approach to meet the patient's requirements should an emergency caesarean section occur. For example, a "prophylactic" epidural instituted soon after the beginning of labor may be lifesaving in a patient with obvious signs of difficult intubation. A clear definition of safe standards of equipment and practices both to prevent Mendelson's syndrome or to cope with a failed intubation through a "failed intubation drill" is of paramount importance. Finally, a comprehensive communication between anesthetic and obstetrical teams is one of the most useful ways to allow a safer approach of the management of obstetric emergencies such as caesarean section for fetal distress.
胎儿窘迫的麻醉通常用于急诊剖宫产。全身麻醉是这些病例中的经典技术，仍然是麻醉相关孕产妇死亡的主要原因。困难插管和 Mendelson 综合征是这些死亡的主要原因。然而，针对这个问题有几种解决办法。在妊娠晚期进行麻醉前门诊就诊，对患者问题进行更好的评估，以便在发生急诊剖宫产时能采取更合理的方法来满足患者的需求。例如，对于有明显困难插管迹象的患者，在分娩开始后不久实施“预防性”硬膜外麻醉可能会挽救生命。明确设备和操作的安全标准定义，以预防 Mendelson 综合征或通过“困难插管演练”应对插管失败至关重要。最后，麻醉团队和产科团队之间的全面沟通是使诸如因胎儿窘迫进行剖宫产等产科紧急情况的管理更安全的最有效方法之一。
