What 's new in obstetric anaesthesia?

Optimized risk management in obstetric anaesthesia and effective labour pain control without prolongation of labour remain key goals for anaesthetists and obstetricians. Improved safety in obstetric anaesthesia in terms of a substantial reduction in the incidence of pulmonary aspiration of gastric contents and in maternal hypoxia related to difficulties in airway management has been achieved worldwide by the preferential use of regional anaesthetic techniques, improved fasting regimens and the mandatory use of non-particulate antacids. When general anaesthesia is unavoidable it should be in the form of rapid-sequence induction and endotracheal intubation and performed only by experienced anaesthetists. For the management of unexpected airway problems, special equipment should always be available (intubating laryngeal mask airways, laryngeal tubes, fibreoptic intubation devices and emergency cricothyrotomy sets). Since early epidural anaesthesia using low concentrations of local anaesthetics in combination with epidural opioids has been shown to decrease the rate of instrumental vaginal delivery, as well as the risk of neonatal respiratory depression, it should be given preference over the initial administration of systemic opioids followed by epidural anaesthesia at a later stage. Early insertion of epidural catheters is particularly recommendable in patients with risk factors related to peripartal and anaesthesia-related complications, e.g. morbid obesity and maternal cardiac or hypertensive disease. Treatment algorithms for dealing with sudden deteriorations in peripartal maternal health conditions must be established. Any critical peripartal maternal problem mandates immediate intervention. If necessary, intensive care measures must be initiated in the delivery room. In particular the management of severe postpartal haemorrhage requires rapid fluid replacement with crystalloid and colloid solutions via large-bore intravenous catheters, acid-base and electrolyte adjustment, patient warming and uterotonic agents. Persistent bleeding requires invasive haemodynamic monitoring, substitution of blood products and goal-directed coagulation therapy.