Shanghai_Forum（夏云）.ppt

ASA Practice Guidelines for Obstetric Anesthesia 1999 Practice Guideline The ASA Practice Guidelines for Obstetric Anesthesia was initially developed in 1998 and published in 1999. 2007 Practice Guideline Revised the Practice Guidelines was approved in October 2006 during the ASA Annual Conference in Chicago and published in Anesthesiology, April 2007. So, what has changed since 1999? I. Perianesthetic Evaluation围麻醉期的评估 II. Aspiration Prevention误吸的预防 液体饮料 在待产期间，适当地饮用液体饮料可使病人减少口渴、提神、补充能量、以及增加舒适感 无渣的液体饮料（clear liquid），也就是国内所说的清流食， 譬如：清水、无渣的水果汁、汽水、清茶、和不加牛奶的咖啡等 择期剖宫产无合并症的正常产妇可饮用clear liquid 至麻醉诱导前 2小时 孕妇饮用的液体种类比饮用的液体容量更有临床意义 产妇有下列情况应适当限制液体的饮用： 胃肠动力失调， 譬如：肥胖症、糖尿病、胃食管反流等情况 困难气道 有需手术分娩的可能性，譬如：胎儿健康情况不明、产程进展缓慢等情况 固体食物 生产期间应禁忌固体食物。 择期剖腹产的患者应与其他择期手术的患者一样禁食6-8 小时以上。 手术的时机应依据进食的种类和量而定。 Aspiration Prevention 枸橼酸钠 (Antacids) 法莫替丁(H2 Receptor Antagonists) 甲氧氯普胺 (Metoclopramide) 罗哌卡因特点 新型长效酰胺类局麻药。它的结构、作用强度(ED95)和药效学相似于布比卡因 感觉神经阻滞满意 低浓度：感觉阻滞和运动阻滞分离 高浓度：运动神经阻滞恢复快 罗哌卡因心脏、神经毒性小 收缩血管，无需用肾上腺素 Sanders ， Anaesthesia. 2004 ;59:988-92 Khaw KS，Anesthesiology. 2001;95:1346-50. 罗哌卡因在临床中的应用 硬膜外麻醉和镇痛 如下肢手术和剖宫产等 PCEA: 分娩镇痛、术后镇痛 神经阻滞 局部浸润 罗哌卡因分娩镇痛 安全而有效的长效局麻药 高浓度：起效快 低浓度：感觉与运动阻滞分离适用于“可行走”性硬膜外腔分娩镇痛 镇痛有效（血浆肾上腺素↓） 宫缩影响小、对子宫胎盘血流无明显影响 器械助产率和剖宫产率影响小 母婴安全：对心脏、神经毒性小、不易透过胎盘屏障 The first edition of ASA Practice Guidelines for Obstetric Anesthesia was initially developed in 1998 and published in 1999. I discussed the first edition during the 2005 CSA Annual Conference in Guangzhou. As expected, ASA revised the Practice Guidelines and this updated version was approved in October 2006 during the ASA Annual Conference in Chicago and published in Anesthesiology, April 2007. So, what has changed since 1999? * 2007 OB Anesthesia guidelines also recommended a focused History and Physical Examination. Obstetric patient benefits from communication between the anesthesiologist and the obstetrician. The new guidelines also emphasize an early, continual, and effective communication among anesthesiol