Gin T
Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
Clin Pharmacokinet. 1993 Jul;25(1):59-70. doi: 10.2165/00003088-199325010-00004.
A significant proportion of women require general anaesthesia during pregnancy or for delivery. There are many practical difficulties in studying anaesthetic drugs and techniques to determine what may be best for both the mother and fetus. Physiological changes of pregnancy may alter the pharmacokinetics and pharmacodynamics of anaesthetics and the fetal disposition of drugs is largely unknown. With the limited pharmacokinetic data available, conclusions on the suitability of drugs are reached in conjunction with sophisticated neonatal neurobehavioural testing. The normal fetus appears able to withstand a variety of anaesthetic techniques but there is little information regarding the compromised fetus or premature neonate. Provided that adequate maternal anaesthesia is achieved, it is prudent to choose an anaesthetic technique which minimises fetal exposure to drugs and use agents which can be eliminated quickly by the neonate. Currently available drugs with rapid maternal and neonatal elimination include propofol, suxamethonium, atracurium, nitrous oxide and isoflurane.
相当一部分女性在孕期或分娩时需要全身麻醉。研究麻醉药物和技术以确定对母亲和胎儿可能最有利的方案存在许多实际困难。孕期的生理变化可能会改变麻醉药的药代动力学和药效学，而药物在胎儿体内的处置情况很大程度上尚不清楚。鉴于现有的药代动力学数据有限，结合复杂的新生儿神经行为测试得出关于药物适用性的结论。正常胎儿似乎能够耐受多种麻醉技术，但关于受损胎儿或早产儿的信息很少。只要能实现充分的母体麻醉，谨慎的做法是选择一种能尽量减少胎儿接触药物的麻醉技术，并使用新生儿能快速消除的药物。目前可快速被母体和新生儿消除的药物包括丙泊酚、琥珀胆碱、阿曲库铵、氧化亚氮和异氟烷。
