Der Anaesthesist

, Volume 62, Issue 12, pp 963–972 | Cite as

Neues aus der geburtshilflichen Anästhesie

Leitthema

Zusammenfassung

Hintergrund

Das Risikoprofil der Patientinnen hat sich in der geburtshilflichen Anästhesie wesentlich verändert. Noch mehr als bei anderen Disziplinen lebt gerade die geburtshilfliche Anästhesie daher im wahrsten Sinne des Worts von der engen Abstimmung aller Beteiligten und einer guten interdisziplinären Zusammenarbeit.

Ziel der Arbeit

Der Beitrag klärt über wichtige anästhesiologische Risiken im Rahmen der Geburt auf und vermittelt entsprechende Konzepte zur Prävention, Diagnose und zum Management peripartaler Komplikationen.

Material und Methode

Die Steigerung von Risikoschwangerschaften, die zu einem großen Teil auf eine Zunahme der Adipositas zurückzuführen ist, verlangt nach klar definierten Richtlinien und interdisziplinären Konzepten, die im vorliegenden Beitrag beschrieben und diskutiert werden. Die neuroaxiale Blockade ist weiterhin das wirksamste Verfahren zur Behandlung des Geburtsschmerzes und bietet mit den im Beitrag vorgestellten programmierten intermittierenden epiduralen Boli einen vielversprechenden neuen Modus. Schlussendlich haben die deutschsprachigen Länder Deutschland, Österreich, Schweiz einen Behandlungsalgorithmus für die postpartale Blutung entwickelt, der erläutert wird.

Ergebnisse

Die anästhesiologischen Komponenten einer Risikoschwangerschaft müssen frühzeitig erkannt werden; hierzu gehören u. a. Adipositas, Präeklampsie oder medikamentös-induzierte Koagulopathie. Die Epiduralanalgesie ist das effektivste Analgesieverfahren in der Geburtshilfe. Die patientinnengesteuerte Remifentanilanalgesie stellt – bei Kontraindikationen für ein neuroaxiales Verfahren – aktuell die beste Alternative dar.

Schlussfolgerung

In Risikosituationen, wie bei (Prä-)Eklampsie, notfallmäßiger Sectio caesarea, massiven Blutverlusten oder anderen intrapartalen Notfallsituationen ist die optimale interdisziplinäre Zusammenarbeit zwischen Hebammen, Geburtshelfern und Anästhesisten gefragt. Es sind jedoch nicht nur Notfallsituationen, die eine gute interdisziplinäre Zusammenarbeit erfordern; genauso wichtig ist die Zusammenarbeit im Erkennen von Risikoschwangerschaften und einer frühzeitigen gemeinsamen Planung der bevorstehenden Geburt.

Schlüsselwörter

Schwangerschaft Geburt Epiduralanalgesie Kombinierte Spinal-/Epidural-Anästhesie Postpartale Blutung 

New aspects of obstetric anesthesia

Abstract

Background

The risk profile of patients in obstetric anesthesia has substantially changed. Even more so than other disciplines, obstetric anesthesia is therefore in the true sense of the word dependent on the close coordination of all concerned and a good interdisciplinary cooperation.

Aim

This article explains the important anesthesiological risks connected with parturition and presents the corresponding concepts for prevention, diagnosis and management of peripartum complications.

Material and methods

The increase in the number of high risk pregnancies, which are mostly due to an increase in obesity, require clearly defined guidelines and interdisciplinary concepts which are described and discussed in this article. The neuraxial block is still the most effective procedure for treatment of birth pain and offers a promising new method with the programmed intermittent epidural boluses presented in this article. Finally, the German speaking countries Germany, Austria and Switzerland have developed a treatment algorithm for the management of postpartum hemorrhage which is presented here.

Results

The anesthesiological components of a risk pregnancy must be recognized early and include obesity, preeclampsia and drug-induced coagulopathy. Epidural analgesia is the most effective analgesic procedure in obstetrics. Patient-controlled remifentanil analgesia currently represents the best alternative in cases of contraindications for a neuraxial procedure.

Conclusion

In risk situations, such as pre(eclempsia), emergency cesarean section, massive blood loss or other peripartum emergency situations, optimal interdisciplinary cooperation between midwives, obstetricians and anesthetists is required. However, not only emergency situations require a good interdisciplinary cooperation. Just as important is the cooperation to recognize risk pregnancies and a timely joint planning of the approaching birth.

Keywords

Pregnancy Birth Analgesia, epidural Combined spinal and epidural anesthesia Postpartum hemorrhage 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. Thierry Girard, Stefan Brugger und Irene Hösli geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.AnästhesiologieUniversitätssital BaselBaselSchweiz
  2. 2.Geburtshilfe und Schwangerschaftsmedizin, FrauenklinikUniversitätsspital BaselBaselSchweiz

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