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Anesthésie maternelle durant l’accouchement: effets maternels et fœtaux, devenir cognitif du nouveau-né

Maternal anesthesia for delivery: maternal and fetal effects, neurobehavioral development of the newborn

  • Article de Synthèse / Review Article
  • Published:
Revue de médecine périnatale

Résumé

Le bien-être de l’enfant est un critère majeur d’évaluation en anesthésie obstétricale. Cependant, aucun test n’est spécifique des effets des agents de l’anesthésie sur le nouveau-né. De plus, très peu d’études évaluent spécifiquement ce sujet. Toute anesthésie peut avoir des effets directs ou indirects, bénéfiques ou délétères, sur le fœtus et le nouveau-né. Les morphiniques systémiques peuvent entraîner une dépression respiratoire néonatale. L’anesthésie périmédullaire n’a pas d’effets délétères démontrés sur le fœtus et le nouveau-né. Elle améliore même le statut acidobasique de ce dernier. L’anesthésie générale pour la césarienne peut entraîner une sédation néonatale alors que la rachianesthésie altère le pH. Cependant, le bien-être néonatal ne dépend pas du choix de la technique d’anesthésie. L’attitude consistant à privilégier les anesthésies locorégionales du fait de la diminution de la morbidité et de la mortalité maternelle doit être poursuivie. Les effets à long terme sont peu connus. Il ne semble pas y avoir de différence entre les enfants nés par voie basse ou césarienne, et ce, quelle que soit la technique d’analgésie ou d’anesthésie. Des études prospectives randomisées sont nécessaires pour évaluer les effets spécifiques de l’anesthésie sur le nouveau-né et son devenir à long terme.

Abstract

The well-being of the infant is a major criterion in obstetric anesthesia. There is no test that clearly separates the effects of anesthetics drugs on the newborn. Moreover, few studies specifically evaluate this topic. Drugs given to the mother may affect the newborn either after placental transfer or via an indirect effect. Systemic opioid analgesia depresses the baby. Neuraxial techniques are safe in terms of neonatal outcome and improve acid-base balance of the newborn. General anesthesia may result in transient neonatal depression whereas spinal anesthesia is associated with lower neonatal pH. Newborn outcome was not found to be influenced by the anesthetic technique. Regional anesthesia should be prefered because of maternal safety. Long-term effects of obstetric analgesia and anesthesia are unknown. Nevertheless, long-term neonatal outcome does not seem to be influenced either by the mode of delivery or by the anesthetic technique used. Further prospective randomized studies involving different obstetric anesthesia should include full neonatal assessment on short- and long-term outcome.

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Authors and Affiliations

  1. Service anesthésie-réanimation 1, centre Aliénor-d’Aquitaine, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, F-33076, Bordeaux cedex, France

    B. Richez, L. Saltel, B. Julliac, A. Soulard, E. Millas & F. Sztark

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  1. B. Richez
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  2. L. Saltel
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Correspondence to B. Richez.

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Richez, B., Saltel, L., Julliac, B. et al. Anesthésie maternelle durant l’accouchement: effets maternels et fœtaux, devenir cognitif du nouveau-né. Rev. med. perinat. 5, 222–229 (2013). https://doi.org/10.1007/s12611-013-0254-4

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  • DOI: https://doi.org/10.1007/s12611-013-0254-4

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