剖宫产术全身麻醉的现况和发展方向

Current status and future development directions regarding general anesthesia of cesarean section

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中很少能够实施此类麻醉。目的综述剖宫产术全身麻醉的现况和将来发展方向。内容产科全身麻醉传统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。近年来丙泊酚、罗库溴铵和瑞芬太尼在产科麻醉诱导中的应用越来越广泛。产科全身麻醉的气道管理十分重要，因为不能保证气道安全可导致母亲和胎儿的严重不良后果。对于在全身麻醉下实施剖宫产术的产妇，需要注意维持满意的子宫收缩、防止术中知晓和提供满意的术后镇痛治疗。趋向需要继续努力以改善产科全身麻醉的安全。

Background With the increasing use of neuraxial block techniques, usage of general anesthesia on obstetric patients is decreasing. This tendency means that anesthetists have fewer chances to perform obstetric general anesthesia in their training. Objective This review aims to describe the current status and future research directions regarding general anesthesia usage on cesarean section. Content For obstetric patients, rapid-sequence induction using thiopental and suxamethonium has traditionally been recommended as standard method. In recent years, propofol, rocuronium and remifentanil have been widely used for anesthesia induction in obstetric patients. Airway management during general anesthesia in obstetric patients is very important, because inability to secure airway safety can result in severe adverse outcomes to mother and baby. For parturients undergoing cesarean section under general anesthesia, it is essential to maintain sufficient uterine contraction, prevent intraoperative awareness and provide adequate postoperative analgesic management. Trend Continuous efforts are still required to improve the safety of general anesthesia in obstetric patients.