Hamza J
Département d'Anesthésie-Réanimation, Hôpital Saint-Vincent-de-Paul, Paris.
Cah Anesthesiol. 1996;44(4):309-26.
Foetal distress is a non-specific and imprecise diagnose sometimes associated with surgical delivery of a normal newborn. As this type of delivery is usually considered urgent, emergent anaesthesia is required. General anaesthesia is usually chosen in these cases because it is the quickest anaesthetic technique and because of fears concerning the haemodynamic consequences of regional techniques. Maternal risks of general anaesthesia which is the leading cause of anaesthesia-related maternal mortality (difficult intubation and Mendelson's syndrome) but also neonatal consequences (increased need for neonatal resuscitation) have challenged this policy. Indeed, spinal anaesthesia and extension of a pre-existing epidural analgesia are more and more used during emergency Caesarean section. A better evaluation of the patient's problems based upon a pre-anaesthetic outpatient visit during the last trimester of pregnancy allows a more rational approach to meet the patient's requirements should an emergency. Caesarean section be necessary. For example, a "prophylactic" epidural instituted soon after the beginning of labour may be lifesaving in a patient with obvious signs of difficult intubation. A clear definition of safe standards of equipment and practices either to prevent. Mendelson's syndrome or to cope with a failed intubation drill is of greatest importance. Finally, comprehensive communication between the anaesthetic and obstetrical teams is one of the most useful ways to facilitate safer approach of the management of obstetric emergencies studies. Caesarean section for foetal distress.
胎儿窘迫是一种非特异性且不精确的诊断,有时与正常新生儿的手术分娩相关。由于这种类型的分娩通常被认为是紧急情况,因此需要紧急麻醉。在这些情况下通常选择全身麻醉,因为它是最快的麻醉技术,并且由于担心区域技术对血流动力学的影响。全身麻醉的母体风险(这是与麻醉相关的母体死亡的主要原因,如困难插管和 Mendelson 综合征)以及对新生儿的影响(增加新生儿复苏的需求)对这一策略提出了挑战。事实上,在急诊剖宫产期间,脊髓麻醉和延长已有的硬膜外镇痛越来越多地被使用。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,以便在急诊剖宫产必要时能更合理地满足患者需求。例如,在分娩开始后不久实施的“预防性”硬膜外麻醉对于有明显困难插管迹象的患者可能是救命的。明确设备和操作的安全标准定义,无论是预防 Mendelson 综合征还是应对插管失败的情况都至关重要。最后,麻醉团队和产科团队之间的全面沟通是促进更安全地处理产科紧急情况(胎儿窘迫剖宫产)管理方法的最有用途径之一。