Olthoff D, Rohrbach A
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universität Leipzig.
Anaesthesist. 1998 Nov;47 Suppl 1:S63-9. doi: 10.1007/pl00002501.
In obstetrics, general anaesthesia is increasingly being replaced by peridural anaesthesia. The cases where general anaesthesia is still used are those involving increased risk. It is therefore not surprising that, for example, maternal mortality in cases of caesarian section under general anaesthesia has not decreased. Indeed, large-scale statistical analyses in the USA and the UK show an increase in relative risk. For this reason, continuing efforts have to be made to improve obstetric general anaesthesia. Inhalational anaesthetics have an important role to play, as they represent the only acceptable compromise between the dangers of maternal awareness and neonatal depression. We used literature data and our own experience of urgent caesarian sections to investigate whether the new inhalational anaesthetic sevoflurane is suitable for this purpose. In a comparison of sevoflurane and peridural anaesthesia, there was no difference in outcome for the child and the maternal results showed only the expected procedure-specific differences in circulatory parameters and early postoperative analgesia requirement. A second study involving continuous pEEG monitoring (SEF90) showed advantages of sevoflurane over isoflurane in the initial phase of surgery and in the recovery phase. However, the value of sevoflurane in obstetric anaesthesia will have to be confirmed in more extensive studies.
在产科领域，全身麻醉正越来越多地被硬膜外麻醉所取代。仍使用全身麻醉的情况是那些风险增加的病例。因此，例如，全身麻醉下剖宫产病例的产妇死亡率没有下降也就不足为奇了。事实上，美国和英国的大规模统计分析显示相对风险有所增加。出于这个原因，必须持续努力改进产科全身麻醉。吸入麻醉剂起着重要作用，因为它们是产妇知晓风险和新生儿抑制风险之间唯一可接受的折衷方案。我们利用文献数据以及我们自己在紧急剖宫产方面的经验，来研究新型吸入麻醉剂七氟醚是否适用于此目的。在七氟醚与硬膜外麻醉的比较中，对孩子的结局没有差异，而产妇的结果仅显示了预期的特定手术在循环参数和术后早期镇痛需求方面的差异。第二项涉及连续脑电图监测（SEF90）的研究表明，在手术初始阶段和恢复阶段，七氟醚比异氟醚更具优势。然而，七氟醚在产科麻醉中的价值还需在更广泛的研究中得到证实。
