anesthesia for cesarean section：麻醉对剖宫产

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1、AnesthesiaforCesareanSectionMichelleGros,FRCPCFeb13,2008CesareanSectionCesareansectionrateinCanadain2005was23.7%(CIH)CesareansectionrateinUSnowexceeds24%Incidenceofanesthesia-relatedmaternalmortalityisdecliningAnesthesiaremainsresponsiblefor~3-12%ofallmaternaldeathsMajorit

2、yduringgeneralanesthesia(failedintubation,failedventilationandoxygenation,andoraspiration)Associatedfactorsincludeobesity,hypertensivedisordersofpregnancy,andemergentlyperformedproceduresCesareanSectionReviewofanesthetictechniqueusedforallc-sectionsperformedatBrighamandWom

3、en’shospitalbetween1990and1995GAfrom7.2%in1990to3.6%in1995ArewegettingenoughexperienceinGA’sforc-sections?PreparationforAnesthesia-MedsMinimizedrugspriortodeliveryofinfantIfnecessary,midazolam0.5–1mgorfentanyl25-50ugIVSmalldoses–minimalfetalandneonataldepressionDisadvanta

4、geofbenzos–?Anticholinergics–decreasessecretionsAtropine–crossesplacenta-FHRandvariabilityGlycopyrrolate–doesnotcrossplacentaAspirationprophylaxisPreparationforAnesthesia-MedsCJA2006;53(1):79-85.RCTof60womenEither1ug/kgfentand0.02mg/kgmidazIV,ORanequalvolumeIVNSattimeofs

5、kinprepforspinalNobetweengroupdifferencesofneonataloutcomevariables(Apgar,neurobehaviouralscores,continuousoxygensaturation)MothershadnodifferenceinrecallofthebirthPreparationforAnesthesia–IVFluidsPriortoregional–15-20mL/kgRLorNS30minspriorRoutetal.1993–incidenceofhypotens

6、ionfrom71%to55%ifprehydratedMessage:AdditionalmeansarenecessaryInurgentsituation–notnecessarytowaitforfluidbolushypotension–meansimproveduteroplacentalperfusion?crystalloidvs.colloidPreparationforAnesthesia–IVFluidsCJA2000;47:607-610.Crystalloidpreloadnolongermagicbullet

7、Studyfound1LcrystalloidpreloadwasofnovalueinpreventinghypotensionBothspeedandvolumeofpreloadingunimportantStillreasonabletogivemodestpreloadpriortospinalPatientsareoftenrelativelydehydratedBUT–noneedtodelayemergencysurgeryinordertopreloadPreparationforAnesthesia–IVFluidsSi

8、ddikshowed500mLpentaspanmoreeffectivethan1LNSinreducinghypotension(40%vs.80%)N+Valsoreduc