Anesthesia for Cesarean Section：麻醉对剖宫产.ppt

Anesthesia for Cesarean Section Michelle Gros, FRCPC Feb 13, 2008 Cesarean Section Cesarean section rate in Canada in 2005 was 23.7% (CIH) Cesarean section rate in US now exceeds 24% Incidence of anesthesia-related maternal mortality is declining Anesthesia remains responsible for ~ 3-12% of all maternal deaths Majority during general anesthesia (failed intubation, failed ventilation and oxygenation, and or aspiration) Associated factors include obesity, hypertensive disorders of pregnancy, and emergently performed procedures Cesarean Section Review of anesthetic technique used for all c-sections performed at Brigham and Women’s hospital between 1990 and 1995 GA ? from 7.2% in 1990 to 3.6% in 1995 Are we getting enough experience in GA’s for c-sections? Preparation for Anesthesia - Meds Minimize drugs prior to delivery of infant If necessary, midazolam 0.5 – 1 mg or fentanyl 25-50 ug IV Small doses – minimal fetal and neonatal depression Disadvantage of benzos – ? Anticholinergics – decreases secretions Atropine – crosses placenta - ? FHR and ? variability Glycopyrrolate – does not cross placenta Aspiration prophylaxis Preparation for Anesthesia - Meds CJA 2006; 53(1): 79-85. RCT of 60 women Either 1 ug/kg fent and 0.02 mg/kg midaz IV, OR an equal volume IV NS at time of skin prep for spinal No between group differences of neonatal outcome variables (Apgar, neurobehavioural scores, continuous oxygen saturation) Mothers had no difference in recall of the birth Preparation for Anesthesia – IV Fluids Prior to regional – 15-20 mL/kg RL or NS 30 mins prior Rout et al. 1993 – incidence of hypotension ? from 71% to 55% if prehydrated Message: Additional means are necessary In urgent situation – not necessary to wait for fluid bolus ? hypotension – means improved uteroplacental perfusion ?crystalloid vs. colloid Preparation for Anesthesia – IV Fluids CJA 2000; 47: 607-610. Crystalloid preload no longer magic bullet Study found 1 L crystalloid preload was of no val