Cesarean under general anesthesia. Probable complications after cesarean sections for mom and child

Over the past half a century, Caesarean section has become a widely applicable delivery-based operation when the child is extracted through a cut in the uterus. This became possible due to the use of antibiotics, which significantly reduced the statistics of fatal outcomes.

Indications for a planned caesarean section

• The presence of mechanical obstacles interfering with a natural pathway;
• Mismatch of the width of the pelvic of the manufacture of the fetus size;
• Cross position or pelvic prevention of the fetus;
• Multiple pregnancy;
• Kidney disease and cardiovascular vascular system in a woman;
• Threatening rupture of the uterus, for example, there is a scar from her previous birth;
• The emergence of genital herpes in the third semester of pregnancy;
• Woman's desire.

Types of anesthesia with cesarean sections

Attention! The information on the site is represented by specialists, but is familiarized and cannot be used for independent treatments. Be sure to advise your doctor!

Spinal anesthesia cesarean section It is common in modern maternity homes. This method of anesthesia during surgery has several advantages. Selection of anesthesia is carried out by a doctor. The specialist studies the course of pregnancy and the history of a woman. Only on the basis of the data obtained, the anesthesiologist is determined with the type of anesthesia.

Cesarean section is a traumatic intervention in reproductive system. The operation is accompanied by damage to several tissues. To avoid the development of pain shock, doctors use a variety of painkillers.

With a cesarean section, three types of anesthesia are used: a deep form of anesthesia, spinal or subarachnoid anesthesia, epidural anesthesia. The choice depends on the causes of cesarean section.

Many clinics use anesthesia. This method allows you to adjust the process of surgical intervention. Also, a specialist can choose a drug suitable for long sleep. But European maternity hospitals rarely use anesthesia. Preference is given to spinal or epidural anesthesia. The difference between these methods lies in the peculiarities of the drug administration in the spinal channel.

With epidural anesthesia, a catheter is applied. It is installed in the intervertebral space. Through it is introduced active substance. Spinal anesthesia is carried out using a thin long needle. It is introduced into the cerebrospinal space. A anesthetizing drug is introduced through the needle.

All listed techniques have positive and negative sides. To properly choose the method of anesthetic, you must consult with your doctor. He will explain what problems may arise after surgery. Also, the specialist will allocate the method suitable for each patient individually.

Positive sides of the procedure

Spinal anesthesia has several advantages over ordinary anesthesia. This method is recommended for the following reasons:

The positive effect is the complete preservation of consciousness. Spinal anesthesia applies only to the lower part of the body. The brain and the chest department operates in normal mode. This method of cesarean section gives a woman a chance to control the process and attach a child to the chest in the first minutes after his birth. After anesthesia, the patient takes some time to restore the work of the brain. Spinal anesthesia eliminates a post-class state.

Many women feel the fear of the cesarean section due to the psychological state. The unexplosalness during the operation is accompanied by the development of stress. For this reason, the anesthesia in this way avoids additional inconveniences. The child immediately shows mom. A woman can observe how doctors weighed and measure the kid.

The average duration of the preparation is 120 minutes. This time is enough to carry out all necessary manipulations. In this case, the patient is not experiencing any pain sensations. The drug removes the sensitivity of the abdominal zone, lower extremities and small pelvis. At the end of the surgical intervention, the new mama can make usual actions without additional inconvenience. After a regular anesthesia for two days, restoration is required. Consciousness is returned entirely after this period. Spinal anesthesia eliminates this stage postoperative recovery. On the day of operation, the patient can make a number of permitted actions.

The positive side is the speed of the preparation activity. The first signs of the drug action appear in five minutes. Ten minutes later, a woman can operate. This effect is used for emergency cesarean section. If natural childbirth is not accompanied by the disclosure of the uterus, the doctors are administered anesthetic and quiester a woman.

What else do you need to know

Any appointment of the drug should be carried out by a doctor. Many drugs are provided negative influence On a child. Medications used for spinal anesthesiado not affect the state of the fetus. Such an effect is due to a feature of its introduction. The active ingredient blocks the work of the nerve endings of the spinal column. Due to this, the effect of anesthesia is achieved. The absorption of the drug in the bloodstream is slow. Since all harmful and useful material The fruit gets through the placenta, the harm of anesthesia does not bear.

When using anesthesia, part of the substance is absorbed into the bloodstream. The first day after the cesarean section, the child may be sluggish, poorly takes the chest.

In contrast to many drugs used for anesthesia, anesthetic has a minimal number of side effects. The development of adverse reactions is possible, but is rarely diagnosed.

Negative moments

Spinal anesthesia has a number of negative sides. Unpleasant moments should not be excluded. The appearance of the following is possible negative consequences Intervention:

• soreness in the field of puncture;
• partial numbness of lower extremities;
• migraen headaches;
• sharp decrease in body temperature;
• hypotension.

During the first week after the cesarean section, there may be pain in the field of puncture. Often pain is irradiating into a lumbosk-smoking department. Remove easy sensations Analgesic drugs. In a few days, soreness disappears.

Separate patients have partial numbness of the lower extremities. The problem arises suddenly and also quickly passes on its own. Friend numbers can occur within a few months after the cesarean section. In the first days after surgery this problem more pronounced. If the sensitivity to the legs does not return to the next day after the operation, it is necessary to inform your doctor about it. Specialist will spend medical examination And reveals the reason for such a complication.

A common problem is headacheWearing a migraine character. The pain is striking the temporal and dark zone. There may be a defocus of view and noise in the ears. Not always such pains specialist can completely eliminate. In some women, pain appears during the lifetime due to the temperature difference or changing weather conditions. It should be known that the anesthesia can cause a more complex pathology. Many patients who passed through anesthesia are in the future tormented by the migraines of a long flow.

Spinal anesthesia is introduced into the spinal channel. Reducing the sensitivity of nerve endings affects the temperature indicators of the body. In the first minutes after the administration of the drug, a woman fears. After cesarean section, the temperature decrease occurs periodically. A month later, this pathology disappears spontaneously.

The main problem for many feminine is hypotension. Pathology is characterized by a sharp decrease in blood pressure. The problem arises due to the interrupting of the nervous impulse. Hypotension passes in 3-4 months. But in individual moms it remains life. Critical conditions should be avoided by carrying out additional therapy. Well helps OT. of this ailment Reception of vitamin and mineral complexes.

Risks of the proposed method

Spinal anesthesia has several risks. Before holding a cesarean section, a specialist needs to carefully examine the history of the patient. The presence of any pathologies may affect the course of surgical intervention.

If there is a risk of a long flow of operation, anesthesia does not apply. The effect of the drug is 2 hours. IN some cases Use drugs with duration up to four hours. If it is assumed longer surgical intervention, It should be abandoned by spinal anesthesia.

The experience of a medical worker introducing spinal anesthesia has the importance. Not every doctor can deliver the drug correctly. If a worker has little experience or not enough practice, the action of anesthesia may not come or be brief. Rarely develops swelling due to improper administration of the drug. To avoid such pathology, you need to consult with your doctor and ask the opinion of the patients who have passed spinal anesthesia.

Rarely U. future mom An allergic reaction occurs. A few days before the cesarean section, the doctor polls the patient for the presence of allergic reactions to a variety of drugs. A reaction to the proposed active ingredient is also conducted. If the future mother develops edema or rash, this drug is impossible. But it is not always possible to carry out this study. Cesarean section is carried out in an emergency order. To avoid unpleasant consequences, doctors monitor the patient's condition during operational intervention.

Bans for using the method

The spinal anesthesia is not always resolved for cesarean sections. This method Anesthesia has several contraindications. There are the following prohibitions:

• long-term latexicosis;
• pathological increase intracranial pressure;
• problems with coagulation of blood fluid;
• heart diseases;
• hypoxic defeat of a child.

It is forbidden to use spinal anesthesia with a long period of late toxicosis. This form of toxicosis is accompanied by loss large number moisture. The removal of the fluid is accompanied by a decrease in the volume of the liquid. In the course of the operation there is insignificant bleeding. If the patient needs a cesarean section, anesthesia is used.

Pathological increase in intracranial pressure eliminates the use of many medicines. Spinal anesthesia affects the cereal pressure. A sharp pressure drop causes a cardiac rhythm stop. The choice of anesthetic method is carried out by anesthesiologist.

The main contraindication becomes reduced blood flowing coagulation. In the course of surgical intervention, fabrics and many small vessels are injured. If you use spinal anesthesia, the risk of great blood loss increases. Operation is also eliminated with constant intake of anticoagulant drugs. These medicines dilute blood. Blood lodge will be significant. This pathology Posted in question cesarean section.

The spinal anesthesia is not prescribed and when problems with the cardiac system. A variety of heart defects and work disorders mitral valve Eliminate the use of many medicinal substances. The entire course of the operation is developed by several specialists.

In some situations, the child also suffers various ailments. Hypoxia is considered common pathology. Undage is accompanied by a lack of oxygen. The fruit is experiencing oxygen starvation. In this case, the cesarean section is carried out using anesthesia, as natural childbirth also become impossible.

Preparatory activities

Caesarean section requires a certain preparation of the patient. The use of spinal anesthesia is also accompanied by a number of preparatory activities. A few days before surgical intervention, the following activities are carried out:

• study of the composition of the blood fluid;
• cancellation of concomitant therapy;
• tracking the state of the fetus.

A woman needs to hand over blood from a vein for research. Experts study blood for quantitative and high-quality composition. Elevated level Leukocytes and lymphocytes indicate the development of hidden inflammation. Low erythrocyte content can also be a problem during the operation. If the analysis is normal, the doctor starts to the next phase of preparation.

Some women have chronic pathologies requiring permanent medication. Anticoagulant reception must be excluded. This will avoid the development of bleeding during the cesarean section. Hormonal therapy is canceled. If a woman is exposed to constant therapy, she must inform the doctor about it.

Not only a woman is subject to careful inspection. The condition of the child is also studied. For this purpose, ultrasound diagnostics apply. It is necessary to determine whether the fetus develops correctly, does he have any problems. Also studied the work of the child's heart. For this study on the abdomen of the patient, a special apparatus is enshrined, which responds to the work of the heart of the fetus. All data from it is sent to the computer. Only after all listed activities is selected a anesthesia method.

Characteristics of the procedure

The spinal anesthesia is simple. For the introduction of the drug, a woman needs to lie on one side. Legs bend in the knees and pressed to breast Department. At the top lumbar Department Spine leather is processed by antiseptic solution.

Anesthetic substance is recruited into a special syringe having a long thin needle. The puncture zone is highlighted by a special napkin. The needle is entered between the vertebrae. When passing through the wall spinal cord There is a slight resistance. It indicates the choice of the right area. Medicinal substance Entered into the cavity. The needle is removed.

From that moment on, you need to follow the patient's condition. The first sign of the start of the substance is the feeling of cutting in the puncture zone. Next, the woman notices the loss of the sensitivity of one leg, then the second limb is taken away. After that, the abdomen ends. Conduct cesarean section.

Pregnancy is an excellent period in the life of a woman. Births do not always pass on the planned scheme. If the patient is assigned to the caesarean section, should not be frightened. In this case, spinal anesthesia during cesarean sections is often used.

Of course, childbirth is a difficult and painful process. Anesthesia is able to reduce pain. In this article, we will consider the types of anesthesia used in the cesarean section, but it should be remembered that the choice is always leaving the specialist.

General anesthesia

General anesthesia in the caesarean section is carried out in the presence of contraindications to regional methods, as well as in cases where a woman or operating surgeon does not want to keep consciousness during intervention.

With this form anesthesia, a woman completely loses sensitivity and consciousness, fully anesthesia is ensured and the most importantly, anesthesia is easily transferred to the mother. General anesthesia is possible when you need an immediate operation - Introduction to anesthesia occurs quickly and avoids the consequences in cases of threats to the fetus. Also, among the advantages, it should be noted the complete muscular relaxation and the lack of consciousness in the fempics provide good conditions For the work of the surgeon.

General anesthesia does not affect the stability of the cardiovascular system. Compared to spinal and epidural anesthesia, as a rule, there is no decline in pressure preceding the moment of childbirth, so general anesthesia is a choice for the implementation of cesarean section against the background of the threatened states of the fetus and the severe heart pathology of the mother.

Lighter and more often practiced in operating equipment than spinal or epidural anesthesia. Compared to the methods of spinal or epidural (together both techniques are called regional anesthesia further in the text) anesthesia, general anesthesia preference is preferred by a larger number of anesthesiologists.

General anesthesia is shown:

• In cases where a rapid delivery is necessary, for example, in the threatening states of the fetus.
• In cases where regional anesthesia is contraindicated, for example, due to bleeding.
• In cases where regional anesthesia is impossible due to pathological obesity or an extensive spine operation.
• In cases where the guinea refuses regional anesthesia.

Disadvantages:

1) The risk of impossibility to intubate trachea (put a disposable plastic tube in the trachea and connect the fever to the artificial respiratory unit) for various reasons.

Hypoxia (lack of oxygen) in the manufacturer increases faster due to the reduced capacity of the lungs and a higher need for oxygen associated with an increased metabolic metabolism under generic stress.

2) The risk of aspiration (ingress in light gastric content) is usually associated with the difficulty or inability to quickly protect the respiratory tract.

3) increase pressure and frequency increase in heart rate in response to an attempt to connect to the system artificial ventilation lungs.

4) the oppression of the CNS of the newborn. Common anesthetics are penetrated to varying degrees through a placental barrier, which is fraught with the development of the Depression of the CNS of the Fetal and the newborn. This is of particular importance in cases of prematurity or in situations, when the time interval is extended between the introduction into anesthesia and the delivery (for example, in patients with severe obesity or when there were previously used cesaris sections or other extensive operationsWhen you can expect the development of the adhesive disease of the abdominal cavity).

However, due to the use of modern anesthetic drugs in obstetrics, the oppression of the CNS of the newborn became minimal and short, with the right selection of drugs, it does not have serious consequences and should not be a deterrent for the use of general anesthesia.

Epidural anesthesia

The idea of \u200b\u200bthe regional (acting within the limited part of the body) of the nervous blockade in general, and epidural blockade in particular, is not new. Novelty is only how widely it began to be used in the objective. Anesthetic drug through thin tube-catheterintroduced by a special needle (after anesthetics of the skin of the back by a local anesthetic) enters the space between the spinal cord and its outer shell.

After 1980, the demand for such a procedure soared so rapidly that most anesthesiologists had to learn to use it during childbirth. So the popularity of epidural anesthesia in the family was the reason for the emergence of a new medical systemation - obstetric anesthesiology. The daily use of epidural anesthesia in childbirth revealed new circumstances. Increasingly, there were cases when the decision to resort to Cesarean section was taken already during the actions of epidural anesthesia. And here the benefits of local anesthesia before the general became obvious, because Mom remained in consciousness during the operation and immediately after it.

Disadvantages:

1) the danger of erroneous intravascular administration
The intravascular administration of a large dose of local anesthetic, not detected in a timely manner, can lead to the development of convulsion and a sharp decline in pressure due to toxic action at the central nervous system cardiovascular System. The result of such a complication may be the death of mother or brain damage.

2) the danger of unintentional subarachnoid administration (the introduction of an anesthetic drug under cellic shell spinal cord)
As a result of the undetected subarachnoid introduction of a large dose of local anesthetic, intended for epidural blockade, a total spinal block can develop. If at the same time medical events Loaded, respiratory stop and sharp hypotension, which lead to the cessation of cardiac activity.

Consequently, in each case, before applying the main dose of local anesthetic, a test must be introduced. It is enough 2 minutes of waiting to establish the possible occurrence of the subarachnoid block. In any case, the introduction of local anesthetic, including epidural anesthesia, must have appropriate means for cardiovascular resuscitation at hand.

3) technical difficulties

Epidural technique, compared with general or spinal anesthesia, is more complex. It depends on tactile sensitivity (Roughly speaking golden pens or growing not quite from there where it is necessary). The identification of epidural space is not so distinctly, as in spinal anesthesia, when the appearance of the spinal fluid indicates the correct location of the tip of the needle. In this regard, the frequency of failures in epidural blockades is higher than during spinal anesthesia. The clearance of epidural space is only 5 mm. Invinentible puncture of a solid cerebral shell, which occurs in 2% of cases, can lead to strong post-specific headaches.

4) the elongation of the time between the introduction into anesthesia and the beginning of the operation. It takes 10-20 minutes from the moment of administration to anesthesia (injection of local anesthetic) before the adequate blockade starts. Thus, compared with general or spinal anesthesia, the epidural technique cannot be used when the time interval is limited.

Spinal anesthesia

With spinal anesthesia, the nerve is blocked on its site, which comes out of the spinal cord substance, but still washed by the spinal fluid. It is in this liquid that the blocking agent is introduced. As a result, one injection ensures the blockade of many nerves. The spinal anesthesia causes a deeper relaxation of the abdominal muscles than any of the available inhalation anesthetics. The small dose of needed for spinal anesthesia reduces their toxicity, but still this method is fraught with severe complications.

The spinal anesthesia is very similar to the epidural anesthesia in that it first the intravenously injected fluid, and then with the needle, the injection of local anesthetic is being injected into the space surrounding the spinal cord. The difference lies in the fact that with spinal anesthesia, a needle has a much smaller size and solid brain shell (which is located around the spinal cord) specifically pumped, after which the local anesthetic is introduced directly into the cerebrospinal fluid.

Spinal anesthesia is very effectively coping with pain with caesarean section and imposition obstetric tongsoften even much better than epidural anesthesia.

Taking into account the advantages mentioned above, we believe that spinal anesthesia is the best technique for cesarean sections.

Proper assessment of the deficiencies of the method, the prevention of complications, and in cases of their development - adequate and timely treatment are important additions to the approval expressed.

Contraindications for spinal anesthesia:

• Hypovolemia (blood loss, dehydration, etc.)
• Coagulopathy (blood coagulation disorder).
• Anticoagulant treatment.
• Sepsis
• Bacteremia
• Skin infection at the point of puncture.
• Increased intracranial pressure.
• Allergic reaction to local anesthetics.
• Bradycardia, heart rate disorders.
• Distress, fetal hypoxia.
• The aggravation of herpetic infection.
• Diseases of the central nervous system

Disadvantages:

1) limited duration of action. With a single spinal injection, the blockade duration is limited by anesthetic properties (adequate anesthesia for 2 hours, i.e. interval, which usually overlaps the need for time during cesarean sections).

2) a sharp start of action and a pronounced degree of decline in blood pressure. This deficiency can be leveled by prevention measures.

3) postpunction headache. The frequency of post-specific headaches varies in various medical institutions From 2% to 24% depending on the popularity of the method and experience of employees. The low or moderate degree of severity of the headaches (duration of 1-3 days) has no significant value. Only a strong pronounced postpunction headache is important because it lasts for months and months leads to a loss of ability to work.

4) Neurological complications

a) with anesthesia with one-time introduction

The use of sterile tools, highly purified local anesthetics and auxiliary drugs, good needles ensures the prevention of such serious complications as bacterial or chemical meningitis.

b) with extended spinal anesthesia
As a hazardous neurological complication of this technique, the damage of the horse tail is described. His reasons explain:

1. The erroneous arrangement of the catheter, as a result of which the redundant doses of the concentrated solution of local anesthetic are required, which can lead, ultimately, to a long residual blockade of lower lumbar and sacred nerves.
2. The intraspinal position of the catheter, which is fraught with direct trauma of the spinal cord due to its stretching or breaking into the injected volume of the drug. To prevent such a formidable complication, it should be remembered that if the calculated shared dose of local anesthetic was insufficient to cause the expected block, it is necessary to abandon subsequent injections, the catheter should be introduced again or prefer the method of one-time spinal anesthesia or other anesthesia form.

When a pregnant is carried out an emergency operation, it does not have to choose. But if appointed planned interventionThe patient can independently choose the type of anesthesia.

Cesarean is appointed to women in the presence of absolute or relative readings. Absolute indications include such clinical situations in which the natural delivery is impossible physically. In such cases, childbirth must be carried out only with the help of an operation, even if there is any contraindications to it. Similarly, babies help to be born if the mummy is distinguished by a too narrow pelvis, through which even the head of the newborn can not pass.

In addition, the cesarean section with anesthesia is carried out in the presence of mechanical obstacles, in the role of which moma of the uterus can act ovarian education etc. These tumors are detected at ultrasonic diagnosticsBased on the results of which the planned COP is appointed. Also click pregnant in the presence of a threat of uterus break. Similar risk takes place if available postoperative scar In the uterus after the already conducted cesarean or other operations in the uterine television. COP can be carried out using different species Anesthesia.

Drug varieties at Cesarean

With the help of the cesarean section (COP) today, many children are born. The technique of COP is so improved today that is the most reliable and safe method birth of full I. healthy baby In cases where the natural delivery is impossible. Many pregnant women perspective for the surgical scalpel is not delighted, but the child's health is above all.

A few years ago, types of anesthesia during cesarean section did not differ in particular diversity, because only a common type of anesthesia was used, as with other long-term surgical interventions. But today the varieties of anesthesia are somewhat more: common, endotracheal anesthesia and regional anesthesia, which is represented by epidural and spinal anesthesia.

To prefer to choose a preferred anesthesia, you must first get acquainted with all the varieties of anesthesia, examine their shortcomings and adverse effects.

The total anesthesia at the caesarean section involves an anesthesia, in which the patient is immersed in an artificial medication dream. Today, the use of such anesthesia is usually due to emergency situations, because such anesthesia is characterized by a rather high risk, but does not take much time.

General anesthesia in the cesarean section involves intravenous administration anesthetic. When he begins to act, a woman is put on a mask, according to the anesthetic gas and oxygen. Then the preparation of a minelaxant action is introduced, which relaxes all muscle tissues. Only after all of these manipulations begins directly the operation itself.

Pros and disadvantages

Operation with general anesthesia has its own positive and negative points.

Among the advantages of general pain relief can be allocated:

1. With such anesthesia, the maximum relaxation of all muscle groups is achieved, which gives a doctor wide spectrum surgical manipulations;
2. Properly conducted cesarean section under general anesthesia provides absolute anesthesia;
3. Common anesthesia begins to act quite quickly, immediately after administration, you can proceed to surgical manipulations, which is very convenient if the need for emergency caesarean;
4. With this anesthesia there is no such negative factoras a decrease in blood pressure in pregnant;
5. Such anesthesia does not cause oppression of cardiac activity;
6. Easy execution technique that does not require additional devices or qualified skills;
7. Anesthesiologist can keep the duration and degree of anesthenous sleep under control and, if necessary, increase its duration.

Disadvantages of general anesthesia are reduced to such factors:

Indications for general anesthesia

There are special situations when COP with general anesthesia should be carried out on drug and vital indications. This can include cases requiring emergency surgery, when the threatening state is observed in the fetus, and the mother. Also, the total anesthesia at the COP is used if the woman refused other forms of anesthesia or cannot be carried out (such is characteristic of strong obesity, anomalies or spinal injuries, etc.).

If the patient has contraindications to regional anesthesia like bleeding, it is also recommended to conduct COP with common type anesthesia. General anesthesia is used when cesarean Rhodework More and less, because it has a lot of unwanted adverse reactions, but still, with emergency intervention, its benefits are invaluable.

Endotracheal anesthesia

One of the varieties of general anesthesia is endotracheal anesthesia. It is carried out by introducing a special tube into the trachean cavity communicating with the device for artificial pulmonary ventilation. Through this tube, a woman is served inhalation anesthetic and oxygen. As a result, the pregnant woman flows into a long-term medical sleep, in which no pain does not feel. Endotracheal types of anesthesia allow you to carefully monitor the duration of the patient's stay in an anesthetic dream, so the probability of waking up at the time of the operation is absolutely excluded.

Quite often, such anesthesia is used in conjunction with intravenous anesthesia With a cesarean section in order to increase the duration of anesthetic sleep and to control the respiratory activities of pregnant.

Advantages and disadvantages

The undoubted plus of endotracheal anesthesia with a cesarean section is the rate of introduction into anesthetic sleep, which requires only a few minutes. When it is necessary to carry out an emergency operation, such a speed is very important for the salvation of the life of the baby. In addition, endotracheal anesthesia works 100%, introducing a patient to sleep and providing a complete absence of painful sensitivity.

In comparison with intravenous general anesthesia, the endotracheal is transferred to the ladies is much easier, it is easily controlled by anesthesiologist and at any time can be extended. In addition, the state of the heart rhythm and pressure indicators in the patient with the chosen endotracheal anesthesia remains normal.

Among the minuses of such anesthesia can be noted the risk of oppression respiratory functions Baby and the likelihood of casting content from the gastric cavity in the trachea. In addition, during the introduction of the tube, there is a real risk of a sharp retaliatory increase in pressure from the woman in labor. The undoubted minus of general and endotracheal anesthesia is the impossibility of contacting mom with a newborn after it is extracted. And the drugs that mothers are introduced, penetrate into the kid's blood flow.

When shown, contraindications

The conduct of endotracheal anesthesia is shown if emergency intervention is planned, in the presence of contraindications to other types of anesthesia, with a deterioration in the state of the fetus and well-being of the guinea, as well as with a technically complex and long-term operational intervention, which includes large volume of surgeon manipulations.

Epidural anesthesia

Epidural anesthesia is considered a popular view of anesthesia, which today is increasingly used with COP. Such anesthesia refers to the local or regional varieties of anesthesia. Epidural anesthesia is used during planned CS, because the effect occurs after 20-25 minutes from the moment of administration of the drug.

Epidural anesthesia is carried out by introducing a anesthetic medication into the vertebral epidural space in order to eliminate the sensitivity of the root nerve processes. For this, there is a needle between the solid spinal casing and the wall of the spinal channel, which passes the finest catheter, providing the delivery of anesthetic directly to epidural space.

Then the needle is cleaned, and the catheter is left to the end of surgery, so that, if necessary, it was possible to carry out an additional introduction of anesthetic preparation.

Advantages and disadvantages

What anesthesia is better, it is difficult to say, but epidural anesthesia has their undoubted advantages:

• Great for carrying out the planned caesarean section, because compared to the rest of the anesthesia has a minimal impact on the infant;
• During the operation, the patient is in consciousness all the time, and when the child is removed from the uterus, the mother will be able to see it immediately. Baby can even applied to the breast of women in labor;
• Epidural anesthesia causes some decrease in blood pressure, which makes it possible to infusion larger than the preparations. This ensures excellent prevention of significant blood loss during the intervention;
• Epidural anesthesia significantly reduces the duration of the rehabilitation and recovery postoperative period;
• Since the catheter remains in the spine for the entire operation, then at any time anesthesiologist can introduce an additional dose of anesthetic if a similar need arises.

But with all the advantages of "Epiduralki", it is not necessary to choose it without familiarcing the disadvantages of the method. There are few of them, but they are very significant. For example, the holding of epidural anesthesia requires a highly qualified anesthesiologist, which not all experts of this profile are possessed. In addition, such anesthesia is not suitable for emergency cases, when the question is the question of the salvation of the child's life or the girlfriend.

Anesthetic drug still affects the child, although it is introduced epidural. Since with such an anesthesia, the blood pressure drops, while the drug will not start fully acting, the child will experience some intrauterine hypoxia. Sometimes in the course of anesthesia, anesthesiologists make the wrong puncture, then the drug may not work fully, anesthesia only half of the body.

With insufficient qualifications of the doctor after epidural anesthesia, complications may arise such as toxic poisoning of the patient or infection. Among hazardous complications Experts allocate convulsive seizures, Stop respiratory activities and fatal outcome.

When spend, and when contraindicated

COP with epidural administration anesthetic is shown if the woman suffers from gestosis or renal pathologies, diabetes or hypertension and cardiac vices. Also "Epiduralka" is shown if necessary in a gentle method of pain relief in the process of operational manipulations.

If there is no anesthesiologist in the maternity hospital, which owns the practice of epidural anesthesia, or there is no appropriate equipment and materials, then the conduct of such anesthesia is contraindicated. Do not hold it and if the woman is desired. In addition, if there is a fruit hypoxia and bleeding in the guinea, reduced blood pressure or impaired heals, general infection in the blood or inflammatory infectious damage at the point of puncture, then epidural anesthesia is also not conducted.

If pregnant has the pathology of the spine, all sorts of curvature or damage, then such a kind of anesthesia is also not used. "Epiduralka" is not used in the presence of hypersensitivity to the administered drug, etc. after the procedure, there may be a complication such as head and spinal pains, ureasual disorders, etc.

Spinal anesthesia

A good alternative to epidural anesthesia is spinal anesthesia, but in contrast to it, with a spinal introduction, the needle is placed somewhat deeper, piercing a thick spinal casing. Therefore, such anesthesia is also called the spinal out. Usually, the puncture is carried out between 3-4 or 2-3 vertebra lumbar. The drug is introduced directly into the cerebrospinal mass.

If epidural anesthesia is carried out in a sitting position, then the spinal injection is introduced when the fever lies on the side, pulling the legs as much as possible.

Pros and cons

The positive characteristics of the spinal anesthesia are all the advantages of "epiduralki", but in addition to them there are also specific advantages:

They coincide with spinal and epidural anesthesia and cons, but only after the spinal often there are complications like pain in the back and migraine, which over time pass on their own.

Indications, contraindications

Indications in the spinal introduction of anesthetic similar to epidural anesthesia. An additional indication is the need for emergency intervention, when the total anesthesia is contraindicated. In addition, spinal anesthesia is used when pregnant has no health problems and with pregnancy, since such anesthesia has a limited amount of time, depriving a doctor for the possibility of additional surgical manipulations.

Conducting Cesarean sub local anesthesia The spinal type is not always possible and has specific contraindications. Spinal anesthesia does not apply if the patient lost a lot of blood or suffers from severe dehydration, has violations of blood-blooded and allergic reactions to the use of medicines. It is impossible to use such anesthesia at a high GFD and fruit hypoxia, nervous disorders and exacerbation of herpesvirus infection, problems with heart and inflammatory infections. Also, the operation is strictly forbidden to take anticoagulants that dilute blood.

What anesthesia is better to choose

With a cesarean section, what anesthesia prefer? The question is complicated, because there are no absolutely safe kinds of anesthesia. Each method has specific contraindications and the risk of adverse reactions. General methods anesthesia differ complex tolerability drug addicts and severe rehabilitation. As for minimal damage, this can only be said about the spinal type of anesthesia, which is practically safe for the feminine and a newborn.

The cesarean section is carried out exclusively under anesthesia, since it is expensive. The anesthesia of surgical intervention is discussed in advance if the plan is planned. And a woman can choose one or another kind of anesthesia, but not always. Sometimes it should only do a doctor. In this article, we will tell about what options of choice exist than they differ in what their advantages and disadvantages, as well as we describe situations in which a woman cannot do an independent choice.

What is taken into account when choosing?

The operation includes dissection of anterior abdominal wall, uterus, child extraction and manual separation placenta, after which they impose first internal seams On the uterus, and then external on the incision in the field of peritoneum. Surgical intervention is lasting from 20 minutes to an hour (in specially severe and complex cases), and therefore Under local surface anesthesia, such an operation can be performed.

Today, when conducting cesarean section, two types of anesthesia are used - epidural (and as a kind - spinal or dorsal) and general anesthesia. With an emergency caesarean section, which is carried out to save the life of a child and mother, if something went wrong in natural childbirth, usually general anesthesia is used by default. The question of the choice of anesthesia method during cesarean section is usually resolved only when the operation is planned in advance.

In this case, doctors evaluate the mass of factors. First of all, the condition of pregnant and fetus, possible influence medicines that are used for anesthesia, child and mom. Need to take into account certain contraindications and indications for different types Anesthesia. Regional (epidural) anesthesia has contraindications, while there are no contraindications to the general anesthesia.

Specify the first day of the last menstruation

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Epidural anesthesia

In this way, today is anesthetized to 95% of all cesarean operations in Russian maternity hospitals. The essence of the method is that the introduction medicinal preparation, which leads to the loss of pain sensitivity at the bottom of the body, make through a thin catheter introduced into the epidural space of the spine.

As a result of this introduction, the transfer of nerve pulses in the brain on the cerebrospinal channel is blocked. When such a "space" appears in the CNS chain, the brain simply does not perceive and does not associate the incorrect disorder of the tissue integrity when surgery as a reason to activate the pain center.

The scope of such anesthesia is quite wide, but with natural childbirth to facilitate pain and with cesareous section, such anesthesia is considered less dangerous than with the anesthesia of the cervical spine or hands for operations on the top of the body.

As a rule, anesthesiologists are introduced special, carefully purified solutions that are initially intended exclusively for such an application. Lidocaine, Ropivacaine can be introduced to relieve pain in natural childbirth. But for the cesarean section of such anesthesia will not be enough. Simultaneously with the lidocaine, a certain amount of opiates can be introduced, for example, commotol, morphine or buprenorphine. Often applied ketamine.

Dosage of substances determines anesthesiologist, taking into account the state of health, weight and age of a woman, but for spinal anesthesia Opiates are always required less than when intravenous anesthesia, and the effect can be achieved more prolonged.

How do you do?

A woman lies on a side with a bare back, slightly pursing his legs and leading his shoulders. Anesthesiologist one of existing methods Determines where exactly you need to enter the catheter. For this, they usually use a syringe filled with air, which is connected to the catheter. If the piston meets essential resistance, it means that the catheter is in the binder space. If the resistance is unexpectedly lost, we can talk about the correct detection of epidural space, where and to slowly introduce drugs.

Introduction is stepped. This means that at first the doctor introduces a test dose. After three minutes, the state is evaluated, and if the first signs of anesthesia appeared, loss of sensitivity, enter the remaining parts of the dosage for a particular female dosage into several steps.

A woman can first ask the anesthesiologist, who per day before surgery will definitely meet with it, the name of the drugs that are planned to be entered. But the dosage is better not to ask, because its calculation is extremely complex and is based on numerous factors.

The operation begins after the full blockade of the bottom of the body occurs. In the face of a woman, Shirma is installed so that she does not see the manipulations of surgeons. Throughout the operation, the woman in labor can communicate with doctors, see the main moment - the first breath and the first cry of his baby.

After that, the doctors will begin to impose seams, and the baby may well leave for a few minutes next to her mother so that she can admire the long-awaited cloth insert.

Advantages and disadvantages

Complications after such anesthesia are possible, but in practice they are found only in 1 case by 50 thousand genera. What can be unexpected and negative manifestations? It happens that the blockade of nerve endings does not occur, the sensitivity is preserved, and this, according to statistics, it happens at one woman to 50 operations. In this case, the anesthesiologist urgently decides on overall anesthesia.

If a woman has problems with blood clotting, hematoma can develop at the point of introducing a catheter. The anesthesiologist when introducing the needle may accidentally pierce a solid spinal shell, which is fraught with the leakage of the spinal fluid and subsequent problems with strong headaches.

Inaccurate motions of an inexperienced doctor can lead to the injury of the subarachnoid space, as well as to the development of paralysis. Opponents of general anesthesia suggest that in epidural anesthesia, the injected drugs do not have any action on the child, in contrast to total drug sleep, in which the fever is immersed with general anesthesia. This is not true. Medicines that are introduced for the blockade of pain can cause a reduction in the heart rhythm in the baby, as well as the state of hypoxia or a respiratory disorder after birth.

On the back pain and numbness of the legs, many woman inquiries complain rather a long time after surgery. It is officially believed that the exit time from spinal anesthesia is a period of about 2 hours. In practice, the exit more long.

The advantages of epidural anesthesia can be attributed to the stability of the heart and blood vessels throughout the operation. A significant minus is that not all nervous receptors are blocked. A woman will not feel directly pain, but the unpleasant feelings of attempted to survive her after all.

Many women with caution belong to such anesthesia, as they scare not even complications, and the need to attend their own operation itself is psychologically difficult.

Often, women consider epidural anesthesia and a spinal out one and the same species. In fact, there is no difference for the patient, in both cases the drug is injected into the back. But with the spinal introduction is deeper, and therefore the sensitivity decreases more efficiently.

If the question is fundamental, specify where the doctor plans to make anesthesia - in the epidural space of the spine or to the subpauctural. Otherwise, everything will leak in the same way.

General anesthesia

Previously, it was the only kind of anesthesia of the cesarean section. Now the general anesthesia is resorted to more and less. It is officially explained by the fact that the common anesthesia harms a child and a woman. It is unofficially known that the cost of drugs for spinal or epidural anesthesia is lower, and therefore the Ministry of Health in Russia is strongly recommended by anesthesiologists with all their might convince women to choose regional anesthesia. This question is complicated and ambiguous.

Common anesthesia in operation CS is usually used endotracheal. With it, the woman does not feel anything, he does not hear and does not see, she calmly sleeps throughout the entire surgical intervention, without worrying herself, and without having to do with the issues of doctors who help her baby appear.

How do you do?

Preparation for such anesthesia begins in advance. In the evening, on the eve of the day, the operation was assigned, premedication measures are being held - a woman needs to relax, sleep well, and therefore it is prescribed to a dose of barbiturates or other serious sedatives.

The next day, an atropine dose is introduced in the operating woman to eliminate the heart stop at the time of finding in medical Snow. Analgesics are introduced intravenously. At this stage, a woman, without having been afraid of being scared, falls asleep.

When it is already in a state of sleep, she will be introduced a special tube in the trachea. The intubation is necessary to provide pulmonary respiration. On the tube to the lungs will be supplied with oxygen with an admixture of nitrogen, and sometimes narcotic vapors throughout the operation.

Sleep will be deep, anesthesiologist throughout the intervention will follow the state of the feminine, measuring pressure, pulse, other indicators. If necessary, the dose of administered support drugs will increase or decrease.

Shortly before the end of the surgery surgeon, anesthesiologist begins to reduce the doses of Miorosantes and anesthetics, narcotic substances. When the doses are "reset", the process of smooth awakening begins. At this stage, a tube is removed from the trachea, since the ability to breathe independently, without an artificial ventilation of the lungs, is returned one of the first.

Advantages and disadvantages

Psychologically, common anesthesia is much more comfortable than regional anesthesia. A woman does not see what is happening and does not hear conversations of doctors who can sometimes plunge into shock, and already about the patient lying on the operating table and suppressed. From the state of relaxation and inhibition, the woman comes out quite easily, but only 3-4 days later away from the anesthesia. The final output is considered to be a complete cessation of anesthesia at all levels of physiological and biochemical processes in the body.

Big plus is a complete absence of contraindications, that is, such a method is used for all who need surgical intervention without looking at possible negatively affecting factors. The quality of anesthesia is at the height.

No sensations - neither pleasant nor pain of pain will not feel.TO possible complications Endotracheal anesthesia include probable injuries of the larynx, language, teeth (at the time of the introduction and output of the tube), laryngospasm, the development of individual allergic reaction. Quite often in women after such anesthesia for several days the throat hurts, there is a dry cough (which is especially painful with fresh stomach seams!).

If a woman decides to choose a common anesthesia, she must understand that they will not meet with the child immediately. See the baby she can only in a few hours when she is from the chamber intensive therapywhere they are placed all the operated guides, will be transferred to the postpartum.

However, in some situations, this issue is solved on the spot - a woman can ask the operating brigade to show her baby immediately after she comes to himself. True, whether the new Mom will remember this moment or not, no one will guarantee.

When is the question solves only the doctor?

If a woman who has a planned caesarean section, is configured to a certain kind of anesthesia, she can report this to his attending physician, which will definitely transmit information anesthesiologist. Woman signs informed consent The fact that she agrees to epidural anesthesia either writes a refusal to regional anesthesia.

Specify the reasons why a decision is made in favor of common anesthesia should not be pregnant. She may generally not justify its decision even in a conversation with the doctor.

According to the law, in the event of a written refusal of the guide from epidural or spinal anesthesia, for it automatically use general anesthesia. There can be a second solution here. But here's the inverse situation when a woman would like to be conscious during an operation, can turn differently.

Epidural anesthesia has its own contraindications. And no matter how a woman begged the doctor to make her angle in the back before the operation, in the request will be denied if:

• previously there were injuries or there are spinal deformations;
• in the area of \u200b\u200bthe alleged introduction of the needle, there are signs of inflammation;
• in the manufacture of low and reduced pressure;
• women began bleeding or there is a suspicion of the starting bleeding;
• there is a state of hypoxia of the fetus.

For women with such features, the best overall anesthesia is considered.

The patient's opinion will not be asked about the preferred form of anesthesia and in the event that there is a deposition of cord loops, if a woman has a system infection, if necessary, remove the uterus after removing the baby (by testimony). Such guinea is also carried out only by common anesthesia. Other options are not even considered.