Masui. The Japanese journal of anesthesiology
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Spinal anesthesia is a safe and effective anesthetic technique for cesarean section, considering its simplicity, rapidity, accompanied maternal awareness and distribution of anesthetic agents. The problems of spinal anesthesia, hypotension, postdural puncture headache, failed spinal anesthesia, and its duration, have been investigated. Intravenous fluid therapy may reduce the incidence and severity of the hypotension. ⋯ Spinal opioid has improved the quality of spinal anesthesia. The recommended dose of spinal opioid in the recent obstetric anesthesia textbooks has been reviewed. The recent issue about safety and effectiveness in obstetric anesthesia has been briefly discussed.
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The incidence of intracranial hemorrhage is approximately 1-5 in 10,000 pregnancies. In Japan, it is reported that 184 such cases occurred and 10 of them died in 2006. Neurosurgery during pregnancy is required infrequently however a multidisciplinary approach is mandated and anesthesiologists need to modify neuroanesthetic and obstetric practices to accommodate the safety requirements of the mother and fetus. Following the physiologic changes of pregnancy and fetal considerations in nonobstetric surgery during pregnancy, we present the maternal and fetal considerations in anesthesia for intracranial hemorrhage.
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Although, general anesthesia for cesarean section still seems to be the method of choice in extremely urgent settings, past anesthetic evidence has shown that general anesthesia is with increased risk of anesthesia-related maternal mortality. The major disadvantage with general anesthesia is the risk of aspiration of gastric contents and a "cannot ventilate, cannot intubate" situation. ⋯ This review examines the recent knowledge of these topics. We also describe the benefits and risks of new drugs, such as propofol, remifentanil and rocuronium in general anesthesia for cesarean section.
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Maternal mortality rate in Japan decreased dramatically in the last 50 years. It reached 3.2, one of the lowest in the world. ⋯ Uterine displacement, deeper chest compressions, and early tracheal intubation are essential. Emergency cesarean delivery should be considered as soon as a pregnant woman develops cardiac arrest.
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Recent advances in prenatal diagnosis have made fetal surgery as a possible treatment for a wide variety of fetal diseases. Fetal surgeries consist of minimally invasive fetal surgery such as ultrasound guided procedure and fetoscopic surgery, open fetal surgery, and ex-utero intrapartum treatment. ⋯ For this purpose, anesthesiologists are supposed to know outlines of the fetal treatment in addition to pediatric and obstetric anesthesia, as a member of multidisciplinary team. In this review, outlines of fetal treatment will be introduced and anesthetic considerations for fetal surgeries will be discussed.