国际麻醉学与复苏杂志   2018, Issue (4): 0-0
    
剖宫产术全身麻醉的共识和将来研究方向
温超, 薛富善, 刘亚洋, 刘庆1()
1.中国医学科学院整形外科医院
Current consensus and future research directions regarding general anesthesia for cesarean section
 全文:
摘要:

背景: 随着椎管内阻滞麻醉技术临床应用的增加,产科全身麻醉的数量正在减少,这意味着麻醉医师在培训过程中很少接触此类麻醉。目的:本文综述剖宫产术全身麻醉的一些共识和未来研究方向。内容:在产科患者长期以来推荐应用硫喷妥钠和琥珀胆碱的快速序贯诱导为标准方法,近年来采用丙泊酚、罗库溴铵和瑞芬太尼的麻醉诱导方法已越来越普遍。为了防止吸入性肺炎,通常推荐长时间术前禁食和在麻醉诱导中实施环状软骨压迫,但是这些做法可能需要改变。首个产科麻醉困难气道管理指南已经发布,而且目前公认将声门上气道作为产科气管插管失败的有效气道救援装置。胎儿分娩出后,推荐将吸入麻醉转变为静脉麻醉,以避免宫缩乏力。同时应注意避免术中知晓。全身麻醉剖宫产术的持续性伤口疼痛发生率高于局部麻醉剖宫产术,因此需要采用多模式镇痛方法提供满意的术后镇痛处理。趋势:需要继续努力以改善产科全身麻醉的安全。

关键词: 剖宫产术; 快速诱导; 气道管理; 术中知晓; 术后镇痛
Abstract:

Background: With the increasing use of neuraxial techniques, experience in general anesthesia for the obstetric patient is decreasing. This means that anesthetists are exposed to fewer obstetric general anesthesia in their training. Object: This review aims to describe the current consensus and future research directions regarding general anesthesia for cesarean section. Contents: For obstetric patient, rapid-sequence anesthesia induction using thiopental and suxamethonium has been the recommended standard for a long time. In recent years, anesthesia induction using propofol, rocuronium, and remifentanil have been widely accepted. To prevent aspiration pneumonia, a prolonged preoperative fasting and an application of cricoid pressure during anesthesia induction have been recommended, but these practices may require to be revised. The first guideline for difficult airway management in obstetric anesthesia has been developed. Furthermore, the use of a supraglottic airway is now recognized as an effective rescue device for failed intubation in obstetric patients. After the delivery of a fetus, switching from volatile anesthesia to intravenous anesthesia has been recommended to avoid uterine atony. At the same time, intraoperative awareness should be avoided. The incidence of persistent wound pain is higher when only general anesthesia is used during cesarean section than with regional anesthesia. It is needed to provide an adequate postoperative analgesia using a multimodal scheme. Trend: Continuous efforts are still required to improve the safety of general anesthesia in obstetric patients.

Key words: Cesarean section; Rapid-sequence induction; Airway management; Intraoperative awareness; Postoperative analgesia