OB_Anes_Guidelines-Chinese2011.pdfVIP

C. Emergent C/S 紧急剖宫产 2. Existing epidural 有硬膜外置管者: OBSTETRIC ANESTHESIOLOGY GUIDELINES 1. GA 全麻 10-15 mL 3% 2-Chloroprocaine(T10 level) 产科麻醉实施细则 2011 a. Check airway, Bicitra 30mL, LUD, 4 vital capacity breaths, 3% 2-氯普鲁卡因 10-15mL (胸 10 平面) Analgesia for Labor 分娩镇痛 check fetal heart tones 3. Spinal 腰麻: 5% Hyperbaric Lidocaine 40-50mg A.Patient Preparation 产妇准备 检查气道, 口服枸橼酸合剂 30mL, 左子宫位(20o 侧卧位), 5%高比重利多卡因 40-50 mg Prehydrate with 500-1000 mL LR or NS, monitor BP, pulse ox, 四次深呼吸, 查胎心 4. GA (rarely done)全麻(很少用) FHR (if possible) during procedure, ALWAYS left uterine b. Don’t induce until surgeon ready!! (gowned, scalpel in hand) RSI as above. Etomidate 0.2mg/kg or Ketamine 2 mg/kg if patient displacement(LUD) when supine. 产科医生没有准备好(一切就绪, 手术刀在手)前, 绝不全 hypovolemic. Maintenance 50% O2-50%N2O Iso/Sevo 1.5-2MAC 操作前/中, 输林格氏液或生理盐水 500-1000mL, 血压, 脉 麻诱导！！ till uterus evacuated then decrease to 0.25MAC. 搏氧饱和度, (有可能的话)胎心监护, 卧位时绝对保持子 c. RSI with cricoids pressure: 1-1.5mg/kg Propofol; 1 mg/kg 快速诱导(C.1.c.): 低血压者,用 0.2mg/kg 依托咪酯或 2 宫左倾(右侧腰背部垫高)。 Succinylcholine Check BS, ET CO2, tell OB to start. mg/kg 氯胺酮诱导; 50%氧+50%笑气+异/七氟烷 1.5-2MAC B. Technique 操作 环状软骨加压,1-1.5mg/kg 丙泊酚+1mg/kg 琥珀酰胆碱-快 维持,刮宫干净后减至 0.25MAC Patient sitting or lateral, LOR air/saline, ave. depth of epidural 速诱导, 听呼吸音,测到 CO2,让产科动刀 Uterine Relaxation (may need w/ C/S or retained placenta) space 4 cm, catheter threaded and kept at 4-5 cm, adhesive spray d. Before delivery 50% O2-50% N2O, Iso