[Sevoflurane in obstetric anesthesia]

In obstetrics, general anaesthesia is increasingly being replaced by peridural anaesthesia. The cases where general anaesthesia is still used are those involving increased risk. It is therefore not surprising that, for example, maternal mortality in cases of caesarian section under general anaesthesia has not decreased. Indeed, large-scale statistical analyses in the USA and the UK show an increase in relative risk. For this reason, continuing efforts have to be made to improve obstetric general anaesthesia. Inhalational anaesthetics have an important role to play, as they represent the only acceptable compromise between the dangers of maternal awareness and neonatal depression. We used literature data and our own experience of urgent caesarian sections to investigate whether the new inhalational anaesthetic sevoflurane is suitable for this purpose. In a comparison of sevoflurane and peridural anaesthesia, there was no difference in outcome for the child and the maternal results showed only the expected procedure-specific differences in circulatory parameters and early postoperative analgesia requirement. A second study involving continuous pEEG monitoring (SEF90) showed advantages of sevoflurane over isoflurane in the initial phase of surgery and in the recovery phase. However, the value of sevoflurane in obstetric anaesthesia will have to be confirmed in more extensive studies.