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2011 Anesthesiology
Problem based learning with Evidence Base
學習重點：
1. 減痛分娩的使用時機。
2. 減痛分娩的作用機轉。
3. 剖腹生產時的術前評估及注意事項？
4. 產婦剖腹生產時，全身及區域阻斷的優劣點。
5. 術後止痛的方式。
A 37-year-old pregnant woman with a gestational age of 42 weeks (G1P0) and
regular uterine contraction, was admitted for induction.
EBM 1.
產婦問：雖然減痛分娩可以減少產痛，但對於我的孩子會不會有影響？
She received painless labor to palliate her labor pain during induction after
admission.
1. Please discuss the procedures in painless labor. Including:
a、 Necessary evaluation before this procedures
b、 Procedures in performing the painless labor
c、 How is painless labor working to palliate the labor pain?
d、 Indications and contraindications
However, 4 hours after induction, moderate to severe bradycardia (below 80
BPM) with loss of beat-to-beat variability was noted on the fetal heart beat
monitor, and emergent cesarean section was planned under impression of fetal
distress.
EBM2.
產婦問：剖腹生產做區域麻醉或全身麻醉比較好？
2. Discussing anesthesia for the emergent cesarean section. Including:
a、 pre-anesthesia evaluation for a pregnant woman.
b、 Which anesthesia method (general anesthesia with endotracheal
intubations, spinal anesthesia and epidural anesthesia) you will choose for
the patient’s cesarean section? Please discuss the advantages and
disadvantages of each method.
3. How to manage the postoperative pain
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