Caesarean section with general or local anesthesia. Anesthesia for caesarean section: types, consequences, which is better, contraindications

Date: 14.04.2019

C-section(KS) - one of the most common operations in obstetric practice, used in the complicated course of pregnancy and childbirth, allowing to preserve the health and life of the mother and child. Like any surgery, KS surgery requires anesthesia. The two most common methods are general anesthesia and epidural anesthesia. What determines the choice of anesthesia? What are the advantages and disadvantages of each of them? Let's figure it out.

Epidural anesthesia

Epidural anesthesia is a type of regional anesthesia that allows you to eliminate pain in a specific part of the body. In our case - at - in the lower half of the body.

Methodology

Preparation begins 30-40 minutes before surgery. A sterile needle is punctured at the lumbar level and through intervertebral discs the needle enters the epidural space. The anesthesiologist then inserts a soft, thin plastic tube (catheter) through which the medicine (pain relievers) will flow, and the needle will be removed.

information When the drug begins to act, the woman ceases to feel the lower part of the body: pain, temperature and tactile sensitivity, approximately from chest level to the tips of the toes. Moreover, at future mother she retains a clear consciousness: she hears everything, sees and herself can control her condition.

Advantages

A woman remains conscious and is able to independently control her well-being, which allows her, in the event of any discomfort, to inform the anesthesiologist about this so that he can take measures to eliminate them;
Relative stability is maintained of cardio-vascular system from the mother, which avoids the additional administration of other drugs;
The woman in labor breathes on her own, there is no need to intubate the trachea, which means that trauma and irritation of the upper respiratory tract;
If it is necessary to prolong the operation, an additional dose of the drug can be injected through the left catheter, which will allow it to be stretched for the required time, and after the operation, add narcotic analgesics to facilitate the postoperative period;
The general harm to a child from epidural anesthesia is not great due to the lack of many drugs used in general anesthesia. However, depending on what medicines were used (only anesthetics or also narcotic drugs), some complications are possible: a decrease in the child's heart rate, hypoxia, respiratory failure. With the competent approach of a pediatrician-neonatologist, all these complications can be easily eliminated.

Flaws

Conducting epidural anesthesia requires a highly qualified doctor, since the lumen of the epidural space is only 5 mm, there is a high probability of affecting the dura mater, which can subsequently lead to severe headaches (2% of cases);
From the time of administration of the drug to the start of the operation, at least 20 minutes must pass, which makes it difficult to use this method in emergency cases;
Sometimes the catheter can be misplaced, which can lead to unilateral pain relief and discomfort during surgery. Therefore, before starting the operation, it is imperative to check the sensitivity on both sides and only then proceed to the operation;
In view of individual characteristics the body may damage the nerve root in isolation with a needle or catheter, with the subsequent occurrence of neurological complications (headaches, which in rare cases can drag on for several months).

General anesthesia

In most cases, this method of anesthesia is used in emergency situations or when epidural anesthesia is not possible (there are contraindications or there is no proper technical support). The woman is unconscious throughout the operation and does not feel anything.

Methodology

General anesthesia for caesarean section is carried out in three stages. First, the woman is given a "pre-anesthetic" intravenously, allowing her to fall asleep, and then the trachea is intubated. A tube is inserted into the lower part of the windpipe, through which oxygen and anesthetic gas will flow in the future. The third stage is the introduction of muscle relaxants, which relax all the muscles of the body, including the uterus. After that, the operation begins.

Advantages

It does not take much time to enter into anesthesia;
The lighter and more commonly practiced technique;
Has practically no contraindications for use;
Creates excellent working conditions for surgeons and anesthesiologists;
The state of the woman's cardiovascular system during the operation is more stable.

Flaws

There is a risk of aspiration of the lungs by gastric contents;
Difficulties may arise with tracheal intubation, its trauma and, as a consequence, the occurrence in the postoperative period of sore throat, cough, respiratory tract infection, pneumonia;
A large number of drugs administered during general anesthesia can adversely affect the mother and affect the child;
Anesthetics and narcotic substances used for anesthesia have a depressing effect on the child's nervous system, expressed in lethargy, lethargy and drowsiness. May also cause breathing problems in the newborn, which may require resuscitation by the neonatologist.

Which anesthesia to choose?

At the stage of preparation for a planned caesarean section, in most cases, the choice between general anesthesia and epidural anesthesia remains with the expectant mother. However, here it is necessary to take into account the equipment of the maternity hospital and the qualifications of specialists.

important In addition, if there are contraindications to epidural anesthesia (acute infectious diseases, injuries and diseases of the spine, bleeding disorders, oblique or lateral position of the fetus), no matter how you would like to be present at the time of the appearance of the baby, for your safety they will not be able to allow you to do this.

Let's summarize and compare these two types of anesthesia.

Epidural anesthesia	General anesthesia
The mom-to-be is awake, in control	Complete unconsciousness
You can see and hear the baby as soon as it is removed from the uterus	The child can only be seen a few hours after the operation
Numbness in the legs disappears 3-5 hours after surgery	After waking up from anesthesia, it takes time to recover.
In the postoperative period, headaches and back pain may occur.	Cough, sore throat, headache- the most frequent symptoms arising after general anesthesia
Less use medical supplies avoids complications in the newborn	Narcotic substances adversely affect the nervous and respiratory system of the baby

Additionally

There is another type of regional anesthesia - spinal. It differs from epidural anesthesia in that the drug is injected into the cerebrospinal fluid once and the catheter is not used. Advantages this method consists in easier technical implementation and the ability to use it in emergency cases. However, there is also a drawback: the amount of the injected drug must be strictly and correctly calculated for the operation time, therefore, in the event of unforeseen operational complications and the need to extend the operation time, you will have to switch to general anesthesia.

The method of anesthesia for cesarean section is determined by the anesthesiologist individually for each woman in labor and depends on the reason that led to the operation, on the condition of the pregnant woman and the fetus, as well as on the type of operation: planned or emergency cesarean section.

Epidural anesthesia

During a caesarean section, the following anesthesia techniques can be used:

... With this method, only the lower half of the body is anesthetized, including the site of the operation.
General anesthesia(endotracheal anesthesia).

Epidural anesthesia for caesarean section

Epidural anesthesia during labor is one of the effective methods, however, it is technically more difficult than spinal and requires special equipment and a certain qualification of an anesthesiologist. Epidural anesthesia is performed to relieve pain in both normal labor and caesarean section.

Epidural anesthesia is usually performed with the mother sitting upright or curled up on her side to give the anesthesiologist optimal access to the spine. If the test dose is successful, a catheter is usually left in the epidural space, through which the drug is added as needed, the dose of which is varied as needed.

Indications for Epidural Anesthesia: gestosis - improves renal and placental blood flow; with pathology of the cardiovascular system (reduces the load on the heart and reduces the risk of complications), emergency caesarean section with a full stomach, etc.

Contraindications for epidural anesthesia during labor do not differ from general contraindications : low blood pressure, risk of blood loss, use of anticoagulants, inflammatory reactions at the puncture site, patient refusal, severe spinal deformities, central lesions nervous system.

Potential complications with epidural anesthesia: headache, back pain, arterial hypotension, respiratory distress, dysfunction Bladder, allergies, etc.

Spinal (spinal) anesthesia for caesarean section

In most cases, anesthesiologists choose spinal anesthesia when performing a planned cesarean section. At the same time, the woman in labor is in a wakeful state, which ensures safety from the respiratory tract, the child is born in good condition. Spinal anesthesia also shown at urgent need performing a cesarean section.

The technique can be used even with little experience on the part of the anesthesiologist; anesthesia comes on quickly and provides good conditions for the operating surgeon.

Spinal anesthesia is performed in the same place as an epidural, but with some differences: a thinner needle is used, the dose of anesthetic for the spinal block is much lower and it is injected below the level spinal cord into the space containing the cerebrospinal fluid.

The spinal block is performed while the woman is sitting or on her side. If a woman is sitting on the edge of the operating table, then her feet are on the support, and her body is tilted forward and she rests with her elbows on her knees. The procedure can also be performed when the woman lies on her left side with the hips and knees bent as much as possible. In any case, it is necessary to achieve maximum flexion of the back.

A small area of the back is treated with an antiseptic solution, then a needle is inserted into the space between the two vertebrae for spinal anesthesia. A few minutes after the administration of the drug, a blockade of nerve fibers occurs in the lower part of the body, the woman in labor begins to feel warmth, numbness gradually occurs, sensitivity decreases, muscles relax lower limbs, and the surgeon can start the operation in 5-7 minutes.

After the end of the introduction of the local anesthetic, a sterile gauze napkin is applied to the puncture site, which is fixed with an adhesive plaster. The woman in labor is never allowed to lie on her back, as in this position the uterus compresses the vena cava, causing hypotension (a decrease in blood pressure). Therefore, the woman lies on her side, this is achieved either by tilting the operating table or by inserting a roller under the right side. The uterus shifts slightly to the left and the vena cava is not compressed. During the operation, under spinal anesthesia, women in labor are given an oxygen mask.

As a rule, with spinal anesthesia, the quality of anesthesia is so high that a woman does not even understand that she is being operated on, but when unpleasant sensations which is rare, anesthesia will be immediately supplemented with powerful intravenous analgesics, or the woman will be put on general anesthesia.

Depending on the drug chosen, the blockade can last from one to three hours. After withdrawal from anesthesia, not very pleasant sensations are possible - severe chills.

Advantages of spinal anesthesia over epidural anesthesia for caesarean section.

The effect develops within a few minutes: it is suitable for most urgent operations.
The quality of pain relief is higher than with epidural anesthesia, less often incomplete pain relief occurs.
Spinal anesthesia is technically simpler and therefore reduces the number of failed attempts and complications.
Smaller doses of local anesthetics reduce the risk of toxic reactions to zero by several times.
There is no such formidable complication with epidural anesthesia as total spinal block with an unintentional puncture of a hard meninges.
Considerably cheaper than general and epidural anesthesia.

Advantages of spinal anesthesia over general anesthesia for caesarean section

The woman in labor is conscious when the baby is born, she can hear the first cry of the baby, take him in her arms, in some maternity hospitals it is allowed to attach to the breast immediately after processing the umbilical cord, which contributes to the earlier appearance of lactation and effective reduction uterus.
After general anesthesia, primary recovery period lasts for several hours, during which a woman can be in a lethargic (half-asleep) state, and after spinal anesthesia, the woman remains active and upon arrival at the recovery room, for example, she can report the good news by phone or take care of the child.
Mortality with spinal anesthesia is several times lower than with general anesthesia, since there are no problems with difficult intubation (insertion of a special tube into the larynx through the mouth to eliminate breathing disorders), full stomach, etc.

Contraindications to spinal anesthesia

Patient refusal.
Lack of conditions, if there is no means for resuscitation at hand (no monitoring, no necessary medications, insufficient staff qualifications).
Blood loss, dehydration.
A blood clotting disorder, otherwise severe hypotension may develop.
Treatment with anticoagulants (heparin, warfarin).
Sepsis.
Skin infection at the puncture site.
Increased intracranial pressure.
Allergic reaction to local anesthetics.
Bradycardia, cardiac arrhythmias.
Distress, fetal hypoxia.
Exacerbation of herpes infection.
Diseases of the central nervous system

Urgency, no time.
Fetal malformations, fetal death.
Heart defects, cardiac decompensation.

Potential Complications of Spinal Anesthesia

After spinal anesthesia, the characteristic headache may occur, which may be worse when standing or lifting the head, and ameliorated by horizontal position... It can appear both on the day of surgery and on the second or third day. The localization of pain can be any. Typically, pain occurs in the frontal region, the bridge of the nose, above the eye sockets and in the temples, less often in other areas.

Back pain (in the lumbar spine) after anesthesia; passes on its own in a few days. Usually, you don't even need analgesics.

General anesthesia for caesarean section

With a caesarean section, general anesthesia is performed if there are contraindications to regional anesthesia, as well as in those cases when the woman or the operating surgeon does not want the woman in labor to remain conscious during the operation: when there is a threat to life and an immediate operation is required, since general anesthesia works faster if you suspect tight attachment placenta (if the placenta cannot be manually separated, an emergency removal of the uterus is performed, and the removal of any organ is carried out only under general anesthesia), if local anesthesia fails.

The main risk general anesthesia associated with the control of airway patency. One of the most formidable complications of general anesthesia in obstetrics is aspiration of gastric contents (as little as 30 ml of acidic gastric juice can lead to fatal pneumonitis).

If an operation is to be performed under general anesthesia, the woman will be given an intravenous drug for pain relief, and after a few seconds she will fall asleep. Once her muscles relax, the anesthesiologist will insert a tube into the trachea to keep her lungs safe and control her breathing. At the same time, the woman is in an unconscious state and is connected to the apparatus for artificial respiration... During the operation, the patency of the airways and the state of the vital systems of the body are monitored: blood pressure and pulse are measured.

General anesthesia is a method of pain relief that is currently used only in the most urgent cases.

Needless to say that childbirth naturally are not only physiological, and therefore more "correct", but often less risky for the fetus and even for the woman. However, to our great regret, in some situations it is the birth of a child in a natural way that poses a great threat to his life.

Modern medicine allows you to minimize these risks by offering an alternative - surgical delivery by caesarean section. The operation is carried out either as planned (in cases where natural childbirth impossible for medical reasons), or on an emergency basis (if an acute situation has arisen, when delivery must be carried out immediately).

Because a caesarean section involves cutting abdominal cavity, then, of course, you cannot do without anesthesia. And here women in labor and doctors are given a choice between several methods of anesthesia. It is carried out depending on medical indications, the condition of the pregnant woman and the fetus, the clinical situation that has arisen, the woman's tolerance of the drugs used for anesthesia, and sometimes - taking into account the preferences of the woman herself. An important role is played by the availability of highly qualified specialists and necessary equipment for the operation.

Each type of anesthesia for caesarean section has its own characteristics, indications and contraindications, advantages and disadvantages. All this is taken into account when making a final decision.

Anesthesia for caesarean section: which is better

As with any surgery, general and local anesthesia can be applied during a caesarean section. Local in this case is called regional, and there are two types: spinal and epidural anesthesia. These types of pain relief have a lot in common, but still differ from each other.

It is regional anesthesia for cesarean section that is today a priority, more preferable, safe, modern and widespread than general anesthesia. However, in some cases it is necessary to resort to general anesthesia as the only possible way pain relief during a caesarean section. However, let's talk about this in more detail.

The peculiarity of general anesthesia is that during the period of its impact, the woman's consciousness is completely "turned off". She falls asleep, does not feel and does not understand what is happening to her. Even spontaneous breathing stops: it is carried out thanks to a special tube inserted into the trachea, which is connected to the apparatus artificial ventilation lungs.

General anesthesia is performed by intravenous administration certain drugs. Their action comes instantly, which is used in critical situations, when there is not a minute to wait and delivery is urgently needed. First, a medicine is injected to immerse the woman in labor in sleep, and then - for complete muscle (including uterine) relaxation.

Indications and contraindications for general anesthesia for caesarean section

Anesthesia during caesarean section is used less and less due to the high risks in the form of side effects. But in some situations, it turns out to be the only possible or priority method of pain relief for caesarean, although, as a rule, it is suitable only for healthy strong women who endured this pregnancy without complications. Doctors use general anesthesia if:

it is necessary to carry out an urgent delivery (continuation of pregnancy is vitally dangerous for the mother or child, their condition will rapidly deteriorate);
oblique or transverse presentation of the fetus;
there is a prolapse of the umbilical cord;
the woman has cardiac pathologies (with regional anesthesia, the load on the woman's heart increases);
delivery is impossible in another way (there are contraindications to natural delivery and to the use of regional anesthesia);
a pregnant woman suffers from morbid obesity.

The use of general anesthesia during childbirth is a responsible decision, and all risks must be weighed before taking it.

General anesthesia for caesarean section: pros and cons

The complete blackout of a woman's consciousness during a caesarean section is a great advantage for those of them who, by virtue of different reasons they are very afraid of the upcoming birth, and this also allows surgeons to act more calmly and greatly facilitates their work (all the muscles of the woman in labor are completely relaxed). But the same circumstance can be considered as a huge minus, if a woman wants to participate in the birth process and be the first to meet a long-awaited baby in this world, to share this great happiness with him.

Under general anesthesia, the woman in labor does not feel pain at all. But the consequences of this can be serious. It is almost impossible to predict their appearance. Therefore, you should simply know that due to general anesthesia, the condition of the newborn can worsen significantly. The drugs administered to the mother through the umbilical cord also get to the baby, and those in more, the more time from the moment of the introduction of anesthesia the fetus stays in mother's womb... That is why doctors have to rush or, at the beginning of labor, carry out more superficial anesthesia, with minimal administration of drugs in order to minimize the risks. But at the same time, the woman in labor can remain conscious to some extent and feel pain.

On the other hand, if a woman has arterial hypertension for safety reasons, it is necessary to increase the dosage of anesthesia, which means that the baby is at greater risk.

The consequences of anesthesia for a newborn child can be difficulties with work. respiratory system, slowing down of the nervous system, depression of the brain, etc.

The very same woman in labor can come out of unconsciousness in different ways: muscle and headache, nausea, weakness, weakness, confusion is observed. The consequence of such anesthesia is pain and sore throat, trauma to the lips and oral cavity... Less common are allergic reactions, infectious processes, pneumonia.

The period of postoperative rehabilitation due to anesthesia is lengthened. A newly minted mother cannot immediately attach a baby to her breast.

General anesthesia always carries certain risks, but being pregnant increases them even more. Therefore, this type of pain relief for caesarean section is rarely used today.

In addition, during the operation, a woman may experience aspiration of the airways due to the throwing of stomach contents into them. The development of an acute lack of oxygen in a woman in labor under general anesthesia is not excluded.

Much more justified is the use of regional anesthesia for cesarean. It is not only safer for the mother and child, but also has a number of other advantages, although it is not without its disadvantages as well.

When performing spinal anesthesia, an anesthetic is injected into the spinal canal of the woman in labor (into the cerebral fluid) using an ultra-thin needle. This procedure is almost painless, does not cause much discomfort (sometimes a woman only feels pressure in the back), can be performed in a sitting position, but more often it is performed on her side.

Spinal anesthesia works only in the area below the waist, while the woman remains fully conscious and aware of what is happening. Thus, natural childbirth is imitated: without feeling pain, the mother can remain a participant in the birth process (albeit passive), immediately see and even kiss the newborn baby.

Spinal anesthesia for caesarean section: indications and contraindications

Usually, spinal anesthesia is used in cases where gentle pain relief is required, as well as if pregnant women have some health problems: heart and kidney disease, diabetes mellitus, gestosis.

But she also has a number of contraindications:

Eclampsia.
High intracranial hypertension.
Decreased levels of platelets in the mother's blood.
Disorders in the blood coagulation system.
Infectious inflammation in the area of puncture.
Disorders in the structure of the spine;
Intolerance to drugs used for anesthesia.

Spinal anesthesia for caesarean section: pros and cons

Compared to other types of anesthesia, spinal anesthesia has perhaps the most advantages. It begins to act rather quickly when the minimum dose of anesthetic is administered. Already after 5-10 minutes after the administration of the drug, you can start the operation, and therefore, if time suffers, this type of anesthesia can be used when performing an emergency cesarean. The tenderness in the lower body of the woman in labor is almost completely blocked. At the same time, the muscles relax well, which greatly facilitates the work of surgeons. It is also easier to perform than caesarean surgery under epidural anesthesia.

When using spinal anesthesia, the airways of a woman in labor are not damaged, as with general anesthesia, which is especially important for women suffering from asthmatic diseases. The same goes for epidural anesthesia.

Although with regional anesthesia, approximately the same undesirable consequences can develop, after the use of spinal anesthesia, they occur much less frequently than after an epidural.

The weak concentration of drugs administered during spinal anesthesia can significantly reduce the likelihood of their negative effect on the fetus, although it does not completely exclude it. Perhaps the development of fetal hypoxia during childbirth, a slowdown in the heart rate and depression respiratory function baby.

There are other disadvantages of such births:

The implementation of spinal anesthesia requires the participation of highly qualified experienced anesthesiologists and auxiliary medical personnel, specific equipment and materials, strict adherence to sterility during the operation.
1 in 10 women have postpartum period headaches of varying intensity occur, which, however, are easily relieved with the help of appropriate drugs. Due to a decrease in blood pressure, weakness and nausea are also felt.
Sometimes there are temporary problems with urination.
Allergic reactions to drugs used for anesthesia are possible.
Extremely rare possible neurological disorders at the postpartum woman. However, doctors assure that they disappear within one to two months after childbirth.

In some cases, the dose of the drug administered during spinal anesthesia turns out to be insufficient to completely block the pain, and then general anesthesia has to be applied, since it is impossible to add the drug: the needle is removed immediately after its administration. But if, God forbid, some complications arise during the operation, then provide emergency assistance it will be practically impossible due to the lack of the necessary resources (qualified personnel and special equipment) in Russian maternity hospitals. And therefore, spinal anesthesia is safer. But it should also be said that unforeseen situations practically do not arise during Caesar operations.

Epidural anesthesia for caesarean section

Epidural anesthesia is very similar to spinal in its mechanism of conduction and action. However, there are still some differences. It is also carried out using a puncture in the lumbar spine, but at the same time it provides for the placement of an epidural catheter: if during the operation it is necessary to prolong or intensify anesthesia (as well as in the postoperative period), then this can be easily done by adding anesthetic through a catheter, which is not possible with spinal anesthesia.

In addition, thanks to the same catheter, drugs can be injected into the bloodstream to prevent and stop postpartum hemorrhage, which further shortens and facilitates the postoperative recovery period.

Epidural anesthesia for caesarean section: indications and contraindications

The decision in favor of epidural anesthesia for caesarean section is usually made if there are some complications of pregnancy and stronger anesthesia is contraindicated or may be dangerous. Such indications, in particular, include late gestosis during pregnancy, arterial hypertension, and others. cardiovascular diseases... You cannot resort to this method of anesthesia if the structure of the patient's spine is anatomically incorrect, an infection develops at the site of the intended injection, and the blood coagulation of the pregnant woman is impaired.

Epidural anesthesia for caesarean section: pros and cons

During childbirth, under epidural anesthesia, the mother also remains conscious, but does not feel pain, which is the biggest advantage of regional anesthesia. However, here it will not be superfluous to mention that there are reviews on the Internet, as if an injection with regional anesthesia is far from painless. This depends not only on the patient's threshold of sensitivity, but to a large extent also on the type of needle used for puncture and the experience of the anesthesiologist. Therefore, you need to be prepared for different sensations. However, the main thing is that then pain relief comes anyway, which is the purpose of the injection.

The action of epidural anesthesia occurs gradually, on an increasing basis, which reduces the load on the mother's cardiovascular system. Due to the fact that the duration of the epidural can be increased during the operation, this type of pain relief is especially important for childbirth, which for various reasons lasts a long time. But there are also negative aspects.

The potential consequences for the fetus during epidurals are similar to those for spinal anesthesia. In both cases, to return sensitivity to the woman's legs, it is required certain time at the end of the operation. The consequences of epidural anesthesia for the mother are almost the same as for spinal anesthesia.

Epidural anesthesia, like spinal anesthesia, is relatively complex in technique and requires special training on the part of doctors. If spinal anesthesia begins to work after 5-15 minutes, then epidural - after 20-40 minutes, and therefore it cannot be used in emergency cases (only as planned). But headaches after such an operation occur less often, although their intensity is higher. But in general, epidural anesthesia is slower, and therefore more gentle, and creates less stress on the heart than other types of pain relief.

So, summing up and comparing which anesthesia for a cesarean section will be best, we can definitely say that the advantage is given to spinal anesthesia as it is safer for the fetus. And with the appearance in the arsenal of anesthesiologists, more and more modern medicines and equipment, spinal anesthesia is less and less likely to cause undesirable consequences for the mother. However, everything is determined by the situation and the medical indication.

As a rule, general anesthesia is used, since it takes less time (in comparison with regional, local methods). Under general anesthesia, the woman falls into deep sleep, sees nothing, does not hear, does not feel. General anesthesia is also used quite often.

In this article, we will consider how this type of anesthesia is performed, what are the indications for its use, the disadvantages (complications) and advantages of general anesthesia.

How is general anesthesia performed

When using general anesthesia for a planned operation, the measures for preoperative preparation taking into account the condition of the fetus, the objective data of the woman and the choice of anesthetic aid.

On the eve of a planned operation, it is advisable to prescribe sedatives in order to achieve psychological peace and eliminate the fear of the operation. Premedication (preliminary drug preparation) is carried out 30 minutes before the operation. It is carried out with the aim of preventing a woman's preoperative experiences, preventing allergic reactions, and enhancing the action of drugs for pain relief.

General (aka endotracheal) anesthesia is performed sequentially, in three stages.

A woman is injected intravenously with a drug that completely turns off consciousness and puts her to sleep.
A tube is inserted into the trachea (the lower part of the windpipe) and a mixture of oxygen and anesthetic gas flows through it.
A drug is introduced that relaxes all the muscles of the body, including the uterus.

After that, the operation itself begins.

Pros of general anesthesia for caesarean section

Immediate action of anesthesia, this is very important in emergency operations, when every minute counts;
This is a long-proven procedure that does not require the special skill of an anesthesiologist;
Stable work of the cardiovascular system during the operation;
Low likelihood that blood pressure will drop during surgery. Recall that a drop in mother's blood pressure leads to impaired blood flow of the placenta and fetal hypoxia.
Control of the strength of the action of anesthesia, it is always possible to prolong the anesthesia, if necessary.
The muscles of the woman's body are completely relaxed, which is convenient for the surgeon to work.
Modern drugs for general anesthesia are made in such a way that their negative impact on the child is minimized.
The woman is asleep and cannot (if she wanted to) worry about anything. She doesn't see the operation. With local types of anesthesia, she also does not see the operating zone itself, there is a screen. But she hears everything, sees the faces of the doctors, and so on. And with general anesthesia, she does not see, does not hear, does not feel, - does not worry.

Note. This can hardly be regarded as a "plus", but I personally both times reacted to general anesthesia with a state close to euphoria. This state lasted for about a day (). I was absolutely happy with everything that happened.

Cons and complications of general anesthesia for caesarean section

The most common - cough and sore throat (after the introduction of a tube with an oxygen and anesthetic mixture). This is not very pleasant, because the seam hurts, and it’s scary to even think about coughing. As a rule, it is enough to clear your throat (cough several times) two or three times a day. Try to keep your belly in the seam area, so it is less painful. If you coughed in a dream, then it is better to try to sit down, or get up, so there is less stress on the seam.
Enough frequent complication: Dizziness, weakness, muscle pain, confusion, nausea. With modern drugs, it is less common than before.
More rare complications: pneumonia, respiratory tract infections, allergic reactions.

Complications with general anesthesia (for a child)

The lethargy of the child increased sleepiness... The baby may scream less and move less.
Breathing disorders of the child.
Development perinatal encephalopathy(at toxic effects on the brain of drugs).

In fairness, it must be said that the level of drugs now (2013) is already quite high, and the listed complications in children are rare. And if something does arise, then the correction is made in the hospital, and the mother "goes" home with a healthy baby.

Indications for general anesthesia for caesarean section

If .
Refusal of the patient from regional anesthesia.
If there are contraindications for local anesthesia.
When transverse, oblique. Note. Today, with the transverse and oblique position of the fetus, the operation can be performed with regional anesthesia, but this is not a common practice, and the decision will depend on the specific doctor and. The preferences and wishes of the woman in labor herself are unlikely to be taken into account.
When the umbilical cord loops fall out.
If there are complications that lead to the removal of the uterus. With obstetric bleeding.
Systemic infections, some diseases of the central nervous system.

There are practically no contraindications for the use of general anesthesia.

You can read more about the choice of anesthesia in the article.

The anesthesiologist chooses the type of anesthesia for emergency surgery on his own in accordance with the indications. The decision on the choice of anesthesia for a planned caesarean section is made by the doctor together with the pregnant woman. And what kind of anesthesia for a cesarean section will be better is decided in each a separate case individually.

In contact with

Types of anesthesia used for caesarean section:

regional (spinal; epidural; combined);
general endotracheal anesthesia.

The best type of anesthesia is the one that is perfectly mastered by the anesthesiologist. The main thing is safety. There are indications and contraindications for anesthesia, which are based on the history, analyzes, severity and duration of the operation.

Epidural (spinal) anesthesia for caesarean section: pros and cons

The regional type of pain relief is epidural or spinal anesthesia. The techniques are similar in effect, pain relief, and safety. Regional anesthesia for caesarean section blocks nerve impulse peripheral nerves, which causes loss of sensation in a part of the body.

Pain sensitivity with epidural anesthesia is terminated by drugs inserted through a catheter into the epidural space lumbar spine. There is a blockage of pain impulses that are transmitted to the brain through nerve endings. Complete pain relief develops within half an hour..

Epidural anesthesia is characterized by greater stability of hemodynamic parameters (blood pressure, pulse rate).

Depending on the duration of the operation, catheterization allows the use of short-acting or long-acting analgesic drugs, and, if necessary, administer the doses of anesthetics fractionally.

The negative consequences of epidural anesthesia during cesarean section can only appear if the drug is administered, when it is contraindicated: spinal trauma, bleeding, hypotension.

The epidural can also negatively manifest itself in the case of its incorrect introduction - the cerebrospinal fluid enters the epidural space and causes severe pain... The negative anesthetic can also affect the child - hypoxia, heart rhythm failure. Only serious consequences, in the form of neurological abnormalities, can manifest themselves closer to two years.

Blocking the transmission of pain impulses during spinal anesthesia during caesarean section occurs by the action of analgesic drugs on the roots spinal nerves... The drug is injected through a thin needle into the subarachnoid space of the lumbar spinal cord. Anesthetic dose for spinal anesthesia with a caesarean section, it is much less than for an epidural. Anesthesia takes effect after 5 minutes.

The consequence of spinal anesthesia during a cesarean section can be headaches, a decrease in pressure, weakness, and poor sensitivity.

Combined spinal-epidural anesthesia

Combined anesthesia combines a spinal technique with insertion of a catheter into the epidural space. In this case, there is a deepening and strengthening of spinal anesthesia. As a result, postoperative pain relief is possible when the block is weakened.

V combined anesthesia the advantages of the two methods are combined to reduce the dose of anesthetic administered.

Benefits of Regional Anesthesia:

low complication rate;
hemodynamic parameters are stable (pulse rate, changes in blood pressure);
the ability to communicate with a doctor;
retains tactile (skin) sensitivity;
eliminates pain sensitivity;
postoperative analgesia;
does not affect the level of consciousness;
a mother sees a newborn child;
safety for the child (the risk of drug depression is reduced).

Spinal pain relief for caesarean section gives complete blockade sensitivity in a short time. Epidural anesthesia provides long-term pain relief, enhancement or prolongation of the effect of spinal anesthesia.

Complications:

damage to the central nervous system (anxiety, dizziness, ringing in the ears);
arterial hypotension and bradycardia (change in heart rate);
sudden allergic reaction(anaphylactic shock);
traumatic injury to the periosteum;
puncture of the dura mater (unintentional);
headache.

Regional anesthesia is better tolerated than general anesthesia; safe for the child; reduces the risk of complications and side effects. The mother is conscious and can see the child at the moment of extraction.

The disadvantage of this method is associated with the toxicity of the anesthetic.

General endotracheal anesthesia is used if regional anesthesia cannot be given. General anesthesia is performed in case of emergency or according to indications during a planned caesarean section.

With endotracheal anesthesia, there is a loss of consciousness and a loss of general pain sensitivity against the background of temporary depression of the central nervous system functions. Anesthetics are administered intravenously and through the respiratory system. The doctor selects the optimal dose and combination of drugs for intravenous administration. After intubation, a ventilator is connected.

The advantages of general anesthesia are reliability and speed in preparing for an emergency operation; constant monitoring of the functions of blood circulation and respiration, which is important in case of profuse blood loss; risk reduction arterial hypotension; rapid relief of convulsive syndrome.

Disadvantages of general anesthesia - possible complications and the consequences for the child and the woman in labor. Difficulties lie in intubation and ventilation of the lungs, associated with the risk of ingestion of stomach contents into the upper respiratory tract.

The negative effect on the newborn is expressed in respiratory depression, decreased activity of the muscular and nervous systems. The child is often lethargic, sleepy, lethargic. However, the newborn's drug-induced depression quickly disappears.

The dose of anesthetic drug during the operation is reduced to a minimum and there is no clinically significant negative effect on the fetus.

General anesthesia provides complete medical control of the condition of the woman and the child during the operation. The effect of anesthesia occurs in 5 minutes. The woman in labor is unconscious, feels nothing and does not remember.

Basic safety requirements for anesthesia:

minimal drug exposure to the child through the placenta;
preservation of the natural regulation of the body functions of a woman in labor and a newborn;
maximum pain relief at minimum doses.

All anesthetic drugs affect the fetus. This influence is controlled and not dangerous. However, there may be breathing problems in the newborn. If the caesarean section is performed under general anesthesia, the presence of a neonatologist is mandatory. In case of complications, the child is properly ventilated using special equipment.

V postoperative period high-quality pain relief is important so that the mother can communicate with her child calmly. Non-toxic drugs are prescribed to help the woman adapt.
After epidural anesthesia, the catheter can be left on for 24 hours. Analgesics (fentanyl, pethidine, diamorphine) are administered through the catheter, if necessary. It is possible to use rectal anesthesia (through the rectum). After the operation, within two days, pain relievers in the form of injections are administered intravenously or intramuscularly, then, if necessary, they switch to oral administration of analgesics.

When prescribing painkillers after cesarean, it is taken into account and breastfeeding, therefore, the most harmless drugs are prescribed.

Often, women experience severe headaches after regional anesthesia. The cause of pain is the leakage of cerebrospinal fluid from the puncture.

If the pain does not stop within two days after the operation, then the patient's blood taken from a vein is injected into the lumbar region (the puncture site during anesthesia). This creates a filling or a bloody epidural patch. The blood coagulates and seals the opening from which the cerebrospinal fluid flows. The pain disappears within two days. However, there is a risk of complications when treating headaches with blood patch.

Surgical intervention for a caesarean section is impossible without anesthesia. The choice of anesthesia is approached from the point of view of the least negative impact on the mother and child, excluding side effects and complications.

The decision to carry out a certain type of anesthesia is made by the woman in conjunction with the anesthesiologist. The doctor informs the patient about the benefits of pain relief methods and obtains consent for the operation and the use of a certain type of anesthesia.

As for the general well-being of a woman after cesarean and painkillers, everything is individual here - everyone has their own threshold of sensitivity and susceptibility - one is ready to move mountains after 3 hours, while the other needs much more time to recover. Also, how a woman feels after a cesarean depends on the support and attentiveness of the staff.

A little about epidural and spinal anesthesia for cesarean section in the video:

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