Anesthesia for childbirth - all kinds of anesthesia for future mothers. Why do you need pain relief during childbirth? Can I order Ed in childbirth in advance

Effective childhood pain relief should contribute not only to ensuring comfortable conditions for the feminine, allowing to avoid pain and stress, but also aims to prevent anomalies generic activity.

Individual perception of pain in labor depends on such circumstances as a physical condition, waiting, depression, features of education. Pain in childbirth is enhanced by fear of unknown and possible danger, as well as preceding negative experience. On the other hand, the pain is weakened or is better transferred if the patient has confidence in the successful completion of childbirth, the correct understanding of the delivery process. At the same time, the feminine applies the corresponding breathing exercises, uses the emotional support for loved ones and medical personnel.

None of the current anesthesia techniques in childbirth is not absolutely perfect. To achieve maximum effect, the choice of anesthetic method should be carried out individually. At the same time, it is necessary to take into account the physiological and psychological state of the feminine, the state of the fetus and the obstetric situation.

On the eve of the delivery, it is advisable to interview the patient about the preceding anesthesiological benefits, possible allergic reactions that have health problems and its preferences against anesthesia. It is also necessary to explore the data of laboratory research and conduct a physical inspection, in particular, assessing the state of the upper respiratory tract. One should not forget about the observation of the pity after the completion of intranatal anesthesia to eliminate the possible complications of the anesthetic manual.

An important place in the effectiveness of childbirth is occupied by prepar preparation, the purpose of which is to remove fear of the unknownness of the upcoming birth. In the process of such training, pregnant women inform about the essence of the processes accompanying pregnancy and childbirth. The patient is taught to the right relaxation, exercises that strengthen the muscles of the abdomen and backs that increase the overall tone, in different ways Breathing during battles and at the time of the bodies of the fetus head. It is also necessary to inform the patient that the use of various methods of childhood anesthesia with proper use does not represent danger to the child.

| Anesthesia in the first period of birth

The period of opening the cervix is \u200b\u200bthe longest and painful, since the tension of the circular muscles of the cervix and the lower segment takes place. In this regard, in the first period, all known anesthesia methods use.

| Non-male pain relief

As one of the methods of non-drug pain relief methods, acupuncture can be used. Most often, only partial pain relief occurs when using this method, and most patients need to be applied. additional methods Analgesia.

Another method of non-drug anesthesia of labor is percutaneous electronotimulation (CHANS), which has been used for many years. In the process of birth, two pairs of electrodes are imposed on the back of the woman in labor. The upper steam is placed on both sides of the midline, in the area of \u200b\u200bthe projection of the dermatoms of the rear branches from TH10 to L1. The bottom pair is placed on both halves of the sacrum. The degree of electrostimulation varies according to the need for each specific woman and can be regulated by the patient itself. Usually in the process

Generics use low-amplitude impact, causing a sense of light tingling, with an increase in stimulation during the cuts of the uterus. The range of amplitude is mainly from 1 to 40 mA, with a frequency range of 40-150 Hz and the pulse frequency of 30-250 μs.

The feminine activates the upper pair of electrodes in the first period of birth and includes sacratsal electrodes at the end of the first period. This form of analgesia is safe, non-invasive, easily accessible to a nurse or midwife. The main disadvantage of the method is the difficulty when applying electronic monitoring of the state of the fetus, despite the fact that the Chens itself does not affect the heart rate of the fetus.

| Medical pain relief

The leading importance for the anesthesia of labor has the use of appropriate drugs. Medicines that are used for childhood pain relief can be divided into three types:

Drugs that are inserted parenterally to relieve pain and taking care;

Preparations used for inhalation analgesia and anesthesia;

Medications used for local infiltration and regional blockades.

Drugs for parenteral administration. Narcotic analgesics are the most efficient systemically active drugs used for childbing. However, none of them can provide effective analgesia without manifest side effects for mother and / or fetus. In addition, these drugs are used to a greater extent to reduce than for complete cessation of pain. The most serious side effect of narcotic drugs is the oppression of breathing both mother and the fetus. There is a distinct difference in the manifestation of this effect, depending on the path of administration. The oppression of breathing is most pronounced in 2-3 hours after intramuscular administration or for the 1st hour after intravenous administration of equivalent doses. Another side effect of all narcotic analgesics is orthostatic hypotension due to peripheral vasodilation. IN horizontal position arterial pressure, CSS and heart rhythm remain unchanged, however, when trying to sit down or stand arterial pressure, it can dramatically decrease, which is often accompanied by arrhythmia. As a result of direct stimulation of chemoreceptors of the trigger zones of the oblong brain, nausea and vomiting may appear.

Narcotic analgesics contribute to a decrease in the intensity of generic activity, if they are used in the latent phase of labor or at the beginning of the active phase of the first period of childbirth. With established generic activity in the active phase of the first period of genera, these drugs contribute to the elimination of non-coordinated uterine contractions due to decreasing adrenaline secretion in response to anesthesia.

With a properly selected dosage, the applicable narcotic analgesics exhibit a similar painkillers. The choice of the drug is usually based on the degree of severity of potential side effects and the desired duration of action. It is preferable to intravenous administration of drugs compared to intramuscular, since the effective dose is reduced by 1/3 - 1/2, and the action begins much faster.

In the domestic obstetric practice, the following drugs from a group of narcotic analgesics are used to anesthestics.

Promedol (opioid analgesic) is prescribed intramuscularly as a 2% solution of 1-2 ml. The anesthetic effect of the drug begins to appear after 5-10 minutes and continues for 2-3 hours. Sometimes the shortening of the action of priedol is noted up to 40-60 minutes. It is important to take into account the increased sensitivity of patients to Promedol under protracted births, fatigue, anemia, as well as under congenital and acquired heart defects.

Promedol has an antispasmodic effect on the cervix and can accelerate its disclosure.

Fentanyl (opioid analgesic) is prescribed intravenously or intramuscularly as a 0.005% solution of 0.5-2 ml. The analgesic fentanyl index is 500 times higher than Promedol. In case of intravenous administration, the effect of the drug is manifested after 6-8 minutes. The degree of depressing effect of the drug per respiratory center largely depends on the dose of the drug, speed and method of administration. Slow fractional administration avoids the depression of breathing. In the proposed doses, the drug makes it possible to achieve an anesthetic effect, without causing sleep and not angry contractile activities of the uterus.

Buturofanol (moradol) has agonist antagonistic properties in relation to opiate receptors, injected intramuscularly or intravenously 1-2 mg. After intravenous administration, the effect of the drug begins immediately, and after intramuscular - after 10 minutes. The anesthetic effect is preserved for 3-4 hours.

Pentazocin (FRTL) interacts with opiate receptors. The drug is prescribed at 20-30 mg intramuscularly or 10-20 mg intravenously. The beginning of the drug and its maximum severity is manifested accordingly in 2-3 minutes and 15-30 minutes after intravenous administration and after 15-30 minutes and 30-60 minutes after intramuscular administration. The drug is valid for 3-4 hours. The depressive influence of the drug for breathing is expressed to a lesser extent than at Promedol and Fentanyl. The drug does not have a negative impact on the contractile activities of the uterus. Taking into account this fact, the drug can be used for anesthesia in the weakness of generic activity.

Pentazocine to a lesser extent penetrates a placental barrier compared to all other morphoric drugs, which represents a smaller risk of depression in the fetus.

Tranquilizers and sedatives are used in childbirth as components of drug pain relief for excitation removal, as well as to reduce nausea and vomiting.

Diazepam has antioxidant, anticonvulsant, central minelaxing and sedative effect. Prescribed inward or intramuscularly at 5-10 mg.

A similar effect also has a phenazepam, which is prescribed inside of 0.5 mg.

In the latent phase of labor, when the cervix disclosure is up to 3-4 cm, it is advisable to appoint the listed tranquilizers.

In the active phase of childbirth, when opening the cervix, more than 3-4 cm and the appearance of painful contractions are prescribed sedatives with narcotic analgesics in combination with antispasmodic agents (but-SPAP intramuscularly 2-4 ml of 2% solution, which is 40-80 mg) . The use of narcotic analgesics should be stopped in 2-3 hours before the expected moment of expulsion of the fetus to prevent its possible narcotic depression. The inhibitory effect of narcotic analgesics and sedatives is reflected in reducing the variability of the basal rhythm of the frequency of the fetal heartbeat, according to the CTG. An overdose of drugs should be avoided and the decrease in the intervals of their administration should be avoided, as this may lead to the oppression of the respiration of the fever, the development of depression in the fetus and the weakening of the generic activity.

Inhalation anesthesia of childbirth. The anesthesia of childbirth with the help of inhalation anesthetics is also widely used in obstetric practice. The use of nitrogen (N2O) oxygen, trichloroethylene (trile) and methoxyfluran (pentran) is most common. Inhalation anesthetics are also used in the active phase of labor when opening the cervix at least 3-4 cm and in the presence of pronounced pains.

Nitrogen rushing is a colorless gas with light sweetish odorwhich is the most harmless inhalation anesthetic for mother and fetus.

In concentrations of no more than 70-75% of nitrogen pumping, the gas-coatic mixture does not have the oppressive effect on the respiratory and vascular center, does not reduce gas exchange and does not have toxic impact on the vital functions of the body, does not enter into biochemical metabolic processes, does not negative affects on the contractile The function of the uterus, does not cause deep narcotic depression of the fetus and the newborn.

In case of anesthesia, nitrogen is applied in various oxygen ratios. The smallest concentration in such a mixture is 40%, and the greatest permissible - up to 75%.

The most commonly accepted nitrogen ratios of nitrogen with oxygen are 1: 1, 2: 1 and 3: 1, allowing to achieve the most optimal and stable analgesia. A large concentration of nitrogen zaki does not apply due to the possibility of developing hypoxic hypoxia due to reduction in oxygen content.

The anesthesia of labor using such a gas-coatic mixture is carried out using a special anestrated intermittent unit (NAP-2). The device carries out the gas connotic mixture only to the inhalation phase and is intended for long and intermittent painting of labor by autoanalgesia.

The feminine independently carries out the inhalation of the gas concoctic mixture, depending on the intensity of pain. At the same time, control by medical personnel is needed for the state of the feminine. On the initial stages Analgesia in the first 10-15 min use inhalation with small or average nitrogen zaksi concentrations (no more. 40-50%). During this time, the patient adapts and the effectiveness of analgesia is estimated. Initially, the excitation of the woman in labor, which passes as it adapts to the analgesics. After that, it is individually selected the most effective ratios of nitrogen and oxygen ratios (within 65-75% of nitrogen yarn and 35-25% oxygen), and the female has independently continues to maintain autoanalgesia. The effectiveness of anesthesia is largely dependent on proper technique Inhalation and rationally selected ratios of the components of the gas concoctic mixture.

Three options for achieving an anesthetic effect can be used.

1. The inhalation of the gas concoctic mixture occurs constantly with periodic intervals after 30-40 minutes.

2. Inhalation is carried out with the beginning of the fight and ends with its end.

3. Inhalation occurs only in pauses between the fights so that by the time they started the necessary degree of anesthesia is achieved.

To achieve a more pronounced painkillery effect, especially with pronounced psycho-emotional excitation, the preliminary introduction of tranquilizers (diazepam) is possible.

Autoanalgesia in childbirth With the help of nitrogen zaisi, it is possible to perform throughout the entire active phase of the first period of childbirth to the complete opening of the cervix.

With pronounced pain syndrome In the second period of birth, inhalation can be continued with the ratio of nitrogen and oxygen ratio of 1: 1. In this case, the danger of narcotic depression of the fetus is minimized.

Due to the fact that nitrogen is excreted from the body through the respiratory tract, this ensures greater controllability of the pain relief process.

In case of anesthesia in childbirth, after stopping the inhalation of nitrogen, consciousness and orientation in the surrounding situation is restored for 1-2 minutes.

A similar analgesia in childbirth also has antispasmodic effects, providing coordinated generic activities, preventing the abnormal activities of the uterus and hypocia of the fetus.

A gas-coatic mixture of nitrogen nitrogen with oxygen is the most acceptable in obstetric practice for pain relief.

Trichlorethylene, a strong inhalation anesthetic, is a colorless transparent liquid with a unwitting smell resembling chloroform. The drug has a more pronounced analgesic effect in comparison with nitrogen.

The concentration of trichlorethylene in the inhaled mixture from 0.25 to 1 vol.% Causes the analgesia stage while maintaining the elements of consciousness and relative orientation in the environment. In these safe concentrations of the analgesia trichloroethylene can be maintained for a long time With intermittent inhalation, anesthetic only when pain appears. In this case, trichloroethylene, even possessing the ability to penetrate the placenta, does not have a resistant drug action on the fetus, especially if inhalation stops 30-60 minutes before the end of childbirth. Against the background of the analgesia trichloroethylene, the contractile function of the uterus is saved.

The anesthesia of childbirth is carried out according to the autoanalgesia method. Inhalation of trichloroethylene is carried out together with oxygen, which is fed in concentrations up to 100% using the appropriate devices.

Initially, small concentrations of trichloroethylene are used, not exceeding 0.3% by volume. As the feminine adapts, the concentration of the drug is gradually increased to 1.25-1.5% by volume. Analgesia is supported by an intermittent method. Breaks make every 35-40 min to 10-15 minutes. Thus, it is possible to perform pain reliefing for 4-6 hours.

During the inhalation of trichloroethylene in the patient, against the background of a decrease in pain, a dormant state is marked. The values \u200b\u200bof arterial pressure, pulse and respiration are practically not changed in comparison with the initial level.

30-40 minutes before the second period of delivery, it is necessary to stop the inhalation of anesthetic, since trichloroethylene penetrates through a placental barrier and is capable of cumulation, which can lead to a narcotic depression of the fetus.

In anesthesia, the drug can be used in the mixture with air also on the principle of autoanalgesia using the Trille portable apparatus, which allows you to dose trichloroethylene from 0 to 1.5% by volume, using a intermittent inhalation method.

Metoxifluran is a colorless liquid with a specific odor. The drug is little annoying the mucous membranes of the respiratory tract and is easily transferred by the feminines during long-term inhalation.

Anesthesia of labor by inhalation of methoxyfluran in a mixture with oxygen or with air is carried out with the help of special evaporators by autoanalgesia. At the same time, the concentration of the preparation in the inhaled mixture is 0.2-0.6% by volume.

Metoxifluran is slowly excreted from the body, mainly through the respiratory tract.

Because of the pronounced narcotic effects, the analgesia of methoxifluran is advisable to begin only with the established generic activity, opening the cervix of the uterus at least 3-4 cm, sharply painful fights and a pronounced psychomotor excitation.

The most rational is the use of methoxyfluran for pain relief in patients with congenital and acquired heart defects, arterial hypertension, with gestosis.

The anesthetic effect in the inhalation of methoxyfluran at a concentration of 0.4-0.6 vol.% Occurs after 8-10 minutes. Since the drug is slowly excreted from the body, mainly through the respiratory tract, careful control over the state of the feminine, and the nature of generic activity, as well as timely correction of its impact is necessary.

The use of methoxyfluran is less controlled in comparison with the use of nitrogen and trichloroethylene.

Regional analgesia in childbirth. Regional analgesia can be used to anesthestics.

Taking into account that the cause of pain in the first period of childbirth is cutting muscle muscles, stretching the cervix and tension of the uterine's ligament apparatus, pain in childbirth are observed in the areas of the body combined by the segments of TH10-TH12 and L1.

In the second period of birth, due to the stretching and pulling of pelvic structures, additional painses occur during the promotion of the fetus, which are transmitted through the sacrochny and cleaned nerves. Consequently, to achieve anesthesia in the second period of birth in addition to the segments of TH 10-TH12 and L1, sacral and cockerel nerves should be blocked. This can be achieved by a blockade of sex nerve, sacral (caudal) block, a spinal unit or an extended epidural.

Epidural analgesia. The execution of epidural analgesia is the blockade of pain pulses from the uterus along the efferent paths included in the spinal cord at the level of the TH10-TH12 and L1 segments, when the local anesthetic is introduced into the epidural space.

Epidural space is located inside the spinal column, surrounding the fool bag. The yellow bunch forms the rear border of the epidural space, while the fool bag is located Kepesed from it. Epidural space spreads hard to the base of the skull and caudally to the smoking gap, where it is limited to the dorsal sacrum-cleaned ligaments.

Indications for epidural analgesia are pronounced soreness of the fights in the absence of effect from other methods of anesthesia, hypertensive dysfunction of the uterus, dystation of the cervix, arterial hypertension In childbirth, childbirth during pre-Gestosa and FPN.

Contraindications to epidural analgesia are as follows.

1. Bleeding during pregnancy shortly before delivery. The resulting bleeding and fully eliminated hypovolemia leads to sympathetic activation to maintain blood pressure. At the same time, any effects (including epidural analgesia) blocking sympathetic activity can cause arterial hypotension representing the danger to mother and fetus.

2. The use of anticoagulants or reduced activity of the coagulation system of blood. In this case, when the vessel is injected in the process of performing analgesia, the risk of treatment of hematoma with compression of a horse-tail or spinal cord is increasing, which may entail serious neurological complications. The prophylactic use of heparin, for example, in a patient with deep vein thrombosis in history, is not a contraindication for epidural analgesia, subject to the termination of the introduction of heparin for 6 hours before the procedure is fulfilled and normal indicators Promcrobine Time and Achtv. With the number of platelets, more than 100.0 109 / l, epidural analgesia can be safely implemented without the study of coagulation tests. Due to their amounts ranging from 100.0 109 / l to 50.0 109 / l, a preliminary assessment of the hemostasis system is necessary. With the amount of platelets less than 50.0 109 / l, epidural analgesia is contraindicated.

3. The presence of a focus of infection in the zone of the intended puncture. When the needle passes during puncture through an infected zone, infection is possible. With primary genital herpes or with recurrent herpes with systemic symptoms, epidural analgesia is contraindicated.

4. The tumor in the place of the alleged puncture is also a contraindication to epi-dural analgesia.

5. Volumetric intracranial processes.

Relative contraindications to the execution of epidural analgesia include extensive surgical interventions on the back in history; extreme degree of obesity and anatomical featuresmaking it impossible to identify topographic benchmarks transferred or existing CNS diseases (multiple sclerosis, epilepsy, muscle dystrophy and miastic).

Epidural anesthesia has the right only anesthesiologist who owns this technique.

Epidural analgezia is carried out with the established regular generic activity and opening the cervix at least 3-4 cm.

Previously, before the beginning of the epidural analgesia, it is necessary to collect medical history; inspect the upper respiratory tract and the patient's back; Explain the essence of the procedure and get its consent. An intravenous administration of a crystalloid solution (glucose) should be started. The preparation of the block should be carried out under aseptic conditions. It is fundamentally important to the correct position of the patient, taking into account that the interstitial gaps are expanded by flexing the back.

At the same time, the position on the side is usually more convenient for the patient than a sedentary, and its back must be rented as possible as possible. The skin and subcutaneous fat fiber is infiltrated with the aim of anesthetic in the selected intervertebral interval of the same anesthetic of the local action, which will be used to perform an epidural unit. The skin is punctured by a large diameter needle to facilitate the subsequent introduction of a stupid epidural needle.

The puncture of the epidural space and the introduction of anesthetics is carried out at the level of vertebrae Liii-LIV or LIV-LV. As local anesthetics for epidural analgesia in childbirth, 2% solution of lidocaine, 0.25-0.5% bupivacaina solution, 0.75% solution of ropivacaine is used. The dose of the drug for each woman in labor is selected individually. First, the probe is introduced, and then depending on the mass of the body, the main dose of the drug.

There are two options for continuing epidural analgesia.

1. Repeated administration of a constant dose that provides a block of the th, 0 segment, when pain occurs.

2. The use of constant epidural infusion using the same amount of anesthetic per hour, but in half concentration.

Permanent epidural infusion. After the introduction of the first dose and after reaching the guinea of \u200b\u200ba comfortable state, further maintaining a sufficient level of analgesia can be carried out with a constant epidural infusion of local anesthetic.

Permanent infusion is beginning after half an hour after the administration of the first dose under control over the effectiveness of the anesthesia, the state of the muscular tone and the stability of vital functions.

In the process of infusion every 30 min must be monitored:

1) Block level. At the same time, the infusion rate is regulated depending on the degree of expression of the analgesia;

2) Muscular tone. If a complete paralysis develops, it is possible that anesthetic is introduced into the subpasy space, and the infusion should be discontinued. If anesthesia is absent, then the intravascular arrangement of the catheter is possible or its loss. At the same time, in both cases, the catheter is removed and repeated procedure.

The advantages of a constant infusion before fractional administration are due to a more permanent level of block, a smaller dose of local anesthetic and a decrease in the risk of side effects of medicines.

The advantages of epidural anesthesia include the following: high efficiency anesthetic; During the analgesia, the patient is in consciousness; the possibility of long-term maintenance of anesthetic effects during delivery; lack of depressing impact on generic activities, state of mother and fetus; Optimization of the blood supply to the uterus and kidneys on the background of the sympathetic blockade. If you need to perform an emergency cesarean section, the epidural unit can be strengthened, which makes it possible to ensure the proper level of anesthesia during the operation.

In the process of conducting epidural analgesia, the following complications may occur.

1. With an excessive block on the background of epidural analgesia, a protracted flow rate is possible due to the weakening of the contractile activity of the uterus. In this case, it is advisable to appoint uterotonic tools (oxytocin, forcent F2A). Based on this circumstance is important to monitor the state of the fetus and contractile activity Uterus during childbirth.

2. When the block is spread above the level of the TH10 segment, it is possible to reduce blood pressure. To prevent this complication, it is advisable to carry out such measures as the introduction of 500 ml of crystalloid solutions (glucose) intravenously drip at the beginning of the analgesia; Restriction of the dose of local anesthetic to the real needs of the patient; Location of the patient on the left side.

3. With an intravascular administration of local anesthetic, signs of toxic effects may develop, the severity of which depends on the dose and the rate of administration of the drug. Relatively small doses, introduced intravenously, can cause a feeling of a ring in the ears, a metal taste in the mouth, vision of vision, drowsiness, anxiety strengthening. When these symptoms appear, the further introduction of local anesthetic should be discontinued.

A complete therapeutic dose entered into a catheter accidentally located in a vessel can cause a detached convulsive attack. During convulsion, the patient loses the ability to breathe, which leads to a rapid increase in heavy metabolic and respiratory Acidoza. Ultimately, it can lead to a heart stop. If respiration and blood circulation are effectively supported for a few minutes, the convulsions are completed with the development of amnesia. To prevent such complications when using local anesthetics, a test dose should always be introduced, and the therapeutic dose must be administered fractionally at intervals 30-60 s for the timely recognition of the intravascular ingress of the drug.

4. In case of random contact of the local anesthetic in the subpautical space, an extremely high unit and total spinal analgezia are developing. This leads to a stopping of breathing due to the paralysis of intercostal and diaphragmal nerves and hypotension due to paralysis of sympathetic nerve fibers. Next comes the loss of consciousness and protective reflexes.

In the case of the development of the total spinal block, it is necessary to intubate trachea using pressure on the pisteless cartilage, to begin controlling the respiratory and elimination of the hypotension.

With epidural anesthesia, a decrease in the frequency of fetal heartbeats may be due, which arises for a number of reasons:

Hypotension in a patient, which leads to a decrease in the intensity of the IPC. At the same time, they carry out appropriate therapy;

The aorta comprehension increased by the uterus, which also leads to a decrease in the intensity of the IPC and can be prevented by the position of the manufacture on the left side;

Toxic effects of local anesthetics after their random intravascular administration.

In the epidural analgesia, the second period of childbirth can be lengthened.

Sacred (caudal) analgesia. With a sacred analgesia, a local anesthetic is introduced through the dorsal sacrum-cockerel bundles covering the sacrum slot. With sacred analgesia, the spicker and sacral nerves are first blocked, then lumbar and lower chest. Accordingly, it is necessary to use more high doses Local anesthetic. Sacred analgesia is advisable to spend in the period of expulsion. In this case, it is possible to use a two-liter technique at which the lumbal catheter is used for anesthesia in the first period of birth, and caudal - in the second period. This technique is most useful when high doses of local anesthetics should be avoided.

Paracervical block. In the active phase of the first period of childbirth when the ceroid disclosure from 4 to 6 cm, pain pulses from the body of the uterus and its neck can be blocked by introducing a local anesthetic on two sides of the cervix in the conditional position 4 and 8 hours via the dial. This technique does not apply with complete disclosure and smoothing of the cervix. A 1% solution of lidocaine can be used as a local anesthetic. To reduce the risk of intravascular administration, the anesthetic is better to enter into the submucosal layer.

Anesthesia in the second period of childbirth

If you need to continue anesthesia or there is a need for operational intervention (overlay obstetric tongs), then the methods of choice are epidural, sacral or spinal block, block of floor nerve or inhalation analgesia.

Epidural analgesia in the second period of childbirth. In case of epidural analgesia, to provide adequate adaptation in the second period of birth, it is necessary to block segments from TH10 to the cockerel nerve (only 14 segments). At the same time, 10-20 minutes before the intended time of the parent-examination, the patient is given a half-time position and local anesthetic is introduced to ensure the preparation of the opportunity to achieve and block the sacrats segments. In the case of using a two-tieter technique, a local anesthetic is introduced into every catheter to achieve the anesthesia of the desired nerves.

Spinal angle analgesia in the second period of childbirth. The rigorous analgesia in the second period of birth can be used as for the operational manual in the delivery of natural generic pathsand when independent mans. In the latter case, the patient is sitting in the patient, the lumbar puncture is performed and a 5% solution of lidocaine in an 8% glucose solution is introduced. Analgesia occurs in the crotch area, sufficient for anesthesia in case of dissection of the crotch and the imposition of seams. Such analgesia is comparable to a well-performed bilateral blockade of the floor nerve, but its action is manifested much more (after 2 minutes with a lumbar unit against 10 at a block of sex nerve).

To impose obstetric tongs, a block of the TH10 segment is needed and, accordingly, the dose of lidocaine increases.

Such analgesia has several advantages. In particular, the effect of anesthesia is developing quite quickly, and for several minutes, complete analgesia usually occurs. At the same time, the method of anesthesia is below the risk of toxic effect on the cardiovascular and central nervous system than with epidural analgesia, due to significantly lower doses of local anesthetics.

The disadvantages of the method may include:

Arterial hypotension that can be avoided or weakened by famous preventive measures. It can be easily fastened by fast fluid infusion and intravenous administration of ephedrine;

Limited duration of anesthetic effect.

Block of floor nerve for anesthesia in the second period of birth. Perform 10-20 minutes before the moment when the analgesia of the crotch is required. Anesthesia is achieved by introducing local anesthetic (10 ml of 1% lidocaine solution) on both sides of the pelvis. Each of the sex nerves comes from sexual plexus and leaves the pelvis through a large sedlication hole.

To perform a sexual nerve unit, the anesthetic of local action is administered to the point of the intended passage of the nerve behind the sacral-oest ligament, distal than the sedlicate asset. Then the needle is promoted by 1 cm and an additional anesthetic is introduced for the blockade of the upper stroke nerve in the case of its separate passage. The needle is then promoted by another 1 cm for the rear skin nerve Hips, innervating the skin of the sexual lip and the adjacent part of the thigh. In total, 10 ml of 1% lidocaine on each side are introduced.

The combination of a block of field nerve with inhalation analgesia is advisable when conducting labor through natural generics in high-risk patients, since the block does not negatively affect the character of hemodynamics and the respiratory system of the woman in labor or to the state of the fetus.

To prevent intravascular administration of the drug, an aspiration test must be performed, and it is also necessary to wait 1 min to the execution of the opposite side block.

The main drawback of the method is that it does not remove pain from the contraction of the uterus.

Features of the anesthesia of labor in their complicated flow

In case of gestosis, in the case of childbirth through natural generic paths, it is advisable to use the regional blockade to the level to the level of the TH8 segment, which allows you to block pulses from the uterus, kidneys and adrenal glands and ensures reliable protection of the manufacturer. Horners with gestosis such a blockade reduces blood pressure level on average by more than 20%. In order to avoid arterial hypotension, it is best to use lumbar epidural analgesia with slow, gradually cranial propagation of the unit and with pre-infusion preparation by balanced saline solutions.

The blockade of adrenal innervation makes it possible to avoid provoking the level of catecholamina levels.

In addition, the advantages of using epidural analgezia in the guinea with gestosis are:

The ability to control blood pressure;

Optimization of the IPC;

Improvement of kidney function;

Reducing the need for additional use of depressants providing negative influence on the state of the fetus.

It is advisable to start the blockade with the beginning of the active phase of the first period of childbirth and maintain it up to the delivery.

If there is a need for an emergency delivery by caesarean sections, then the installed block allows you to perform it operational intervention Immediately, even if it is necessary to increase the block level.

If the childbirth is developing very rapidly or conductor anesthesia contraindicated, inhalation analgesia of nitrogen in a concentration of 30-50% in a concentration of 30-50% in the inhaled gas particle mixture can be used to be successfully used. Such analgesia can be enhanced by small doses of narcotic analgesics, and in the second period of clans is supplemented by a block of sex nerve. With such analgezia, the impulse of obstetric forceps or vacuum extraction is also possible.

Anomalies of generic activity. Treatment of pathological probrinarian period It should be started with the central regulation by administering the Sibazone, Sedukssen, Diazepam intramuscularly at a dose of 10 mg or intravenously in 20 ml of isotonic sodium chloride solution.

Adequate timely treatment Hypertensive dysfunction of the uterus (data discordination), as a rule, contributes to its normalization. The choice of appropriate therapy is carried out with regard to the age of women, obstetric and somatic history, pregnancy, objective assessment Fetal states. In this form of anomalous generic activity, the pathogenetically reasonable method of therapy is to conduct long-term epidural analgesia.

In the process of keeping premature birth The use of narcotic analgesics and sedatives should be avoided. Carefully completed regional anesthesia is better view Anesthesia in childbirth and a prevaluation of premature fruit. Extended lumbar epidural unit supported throughout the childbirth is the perfect form of analgesia, as it allows you to strictly control the flow of labor and make a cutting of the crotch. If you need to perform cesarean section, the epidural unit can be quickly enhanced.

Preparations used in the process of similar analgesia do not enter into antagonism with magnesium preparations or? -Adrenomimetics.

Thus, the use of systemic analgesics in the first period of birth can be used to anesthestics in the first period of birth. In the second period of genera, a combination of inhalation analgesia with a block of sex nerve is admissible either with crotch infiltration. Currently, an extended lumbar epidural unit is successfully used for anesthesia.

For a long time, it is known that the distraction and thickening of pain with the help of suggestion are able to change the reaction of the feminine to a painful stimulus. In this regard, the midwife usually has the greatest possibility during normal delivery, since it has the advantage of close contact with the patient. However, to solve this problem with the maximum effect, the feminine must be prepared in advance, before the occurrence of childbirth.

The female consultation is engaged in this preparation, which holds the course of occupations with pregnant women. The purpose of these classes, called the "psycho-philactic preparation for childbirth" - to remove the psychogenic component of labor pain, eliminate the idea of \u200b\u200bits inevitability, eliminate the sense of fear and contribute to the creation of the presentation of childbirth, as a safely occurring physiological process, in which the pain is not mandatory.

In the classroom, the woman introduces basic information about childbirth physiology, their clinical flow, as well as with sensations arising in different periods childbirth. At the same time emphasizes the option of pain. A woman clarify that the performance of certain techniques that are trained in the process of psychoprophylactic preparation for childbirth helps to reduce or eliminate pain.

The system of psycho-philactic preparation of pregnant women has been developed in our country. The physiological foundations are laid by K.I.Platonov and I.I.Velvovsky. The development of the theoretical foundations, the improvement of the method and its popularization belongs to A.P.Nikolaev, F.A. Surovatko, A.I. Dolin and other obsoles and physiologists.

With appropriate preliminary preparation (elimination of fear and concerns, the creation of positive emotions), a calm environment and friendly, friendly attitude towards the Gatherine in the maternity hospital - it is possible to carry out birth without medication anesthesia, which significantly reduces the frequency of depression of newborns.

Ultimately, the methods of psychoprophylactic preparation are designed to reduce the degree of pain, so the failures of this method should not be regarded as the victory of pharmacological approaches to childbirth anesthesia, in contrast, they must stimulate the further development of the method of psychoprophylactic training.

The combination of psychoprophylactic preparation with physical training (physicalopsychoprophylaxis), general ultraviolet irradiation and training of sanitary and hygienic rules in this case, is quite reasonable, as is the organization of group and individual classes on which discusses issues related to diet and hygiene during pregnancy, give initial information about childbirth physiology and child care, conduct practical studies to study the complex exercise, selective muscle relaxation and ability to control breathing.

The effect of the word can be successfully combined with such methods of impact as "white" noise (the sound of rapidly falling water is reproduced in headphones), the power of which a woman can increase during painful contractions.

Acupuncture as a non-toxic method of kindness of childbirth is very promising; However, the lack of specialists and clearly proven effectiveness inhibits its implementation.

There are reports of the percutaneous stimulation of the nerves by electric shock of various power in the field of XI-XII of breast vertebrae. This method is harmless to mother and newborn, but its use is limited due to the lack of appropriate equipment.

In the breakdown of adaptation mechanisms of psychoprophylactic training, drug pain relief should be applied to prevent the fatigue and violation of generic activity.

Drug anesthesia of birth

The use of anesthesia methods depending on the intensity of pain and the degree of opening of the cervix

When appropriate means for pain relief, it should be remembered that there is not a single sedative or sleeping bag, not a single analgesic, which would not penetrate through the placenta and would not affect the fetus in one way or another. Therefore, a thorough choice should be taken for pain relief medicinal preparations Or their combinations, taking into account the state of a particular fever and the maturity of the fetus. It is important and time (period of childbirth) administration of medicines.

Most probable reason Pains during childbirth consider the disclosure of the cervix, so the traditional appointment of painkillers is associated with the magnitude of the opening of the cervix, which is an absolutely incorrect approach, as they need to be guided first of all the intensity of pain. It is known, for example, that the most painful sensations occur when the cervix disclosure is 9-10 cm, but during this period not all drugs can be applied as a result of their side effects. Due to the immaturity of the fetal liver and the newborn, the period of the drug substances can significantly increase, there is not only breathing depression, but also the oppression of reflex activity, arterial hypertension can join. All this indicates that the uniform application of analgesic can not be.

During childbirth, the subcutaneous administration of analgesics should not be applied, since their suction slows down. The most secure is intramuscular administrationHowever, in the urgent situations should move to intravenous administration of anesthetics, despite the increasing risk of complications from the mother, fetus and newborn.

Inhalation anesthetics. Nitrogen, trichlorethylene (trile) and special testimony of fluorotan are used as analgesics in childbirth. Inhalation anesthetic agents are easily penetrated through the placenta. The degree of oppression of the fetus depends on the inhaled concentration and the duration of the inhalation of anesthetic, therefore it is recommended to use the following concentrations: 50% nitrogen rushing, 0.5% fluorotan solution, which does not have a pronounced depressing effect on the fruit even with their long-term use.

Anesthesia in the first period of childbirth.

Nitrogen rushing in a ratio of 1: 1 with oxygen has a satisfactory anesthetic effect and can be used for several hours. For effective anesthesia, it is necessary that inhalation begins before the appearance of pain, which can be achieved when the following conditions are fulfilled. The rate of decrease in pain depends on the depth and frequency of respiration, and deep breathing at a normal frequency is the best condition for the rapid attack of analgesia. If the inhalation of nitrogen pump is carried out during the contraction, the inhalation should be started before it appears that the level of nitrogen nitrogen in the blood of the feminine has been sufficient for an anesthetic effect. The beginning of the cuts of the uterus can be estimated according to the tokogram.

Anesthesia in the second birth period.

In the second period of genera, inhalation of the gas mixture should be carried out before each fertilization. The mask of the anesthetic apparatus should remain on the face and during the sweat so that with short breaths, a sufficient concentration of nitrous nitrogen concentration is maintained. In addition, inhalation anesthesia can be used as a anesthesia component in combination with intramuscularly or intravenously entered analgesics.

T p and l e n is a liquid, when evaporation of which the pairs are formed; At their inhalation, the female inhenico is anneasiating. For the anesthesia, concentrations are used equal to 0.35-0.5 percent in volume. Even such a small concentration is able to cause heart arrhythmias, in connection with which the combination of trile with adrenaline is dangerous. In these concentrations, anesthetic has a slight oppressive effect of the mother and the newborn. Especially dangerous such complication as Tahipne and hyperventilation.

The triennial does not suppress the contractions of the uterus and is used for inhalation when painful contractions in the first period of birth and before the attempts in the second period. Continuously inhalation is carried out during the teething of the fetus head. A distinctive feature of Trien is its slow elimination from the body within a few hours. Therefore, the cumulative effects of Triennia can appear: drowsiness, loss of contact. To prevent these complications, it is recommended to limit the inhalation of 1-2 hours. Indications for the termination of inhalation is Tahipne, arrhythmia, drowsiness, loss of contact with the guinea.

Metoxifluran (Pentran) - Colorless liquid with an unpleasant sweet odor. The concentration of pentrane vapor used for pain relief in obstetrics is 0.35 percent by volume, while the contractile ability of the uterus is not suppressed and the respiratory oppression does not occur. Anesthesia is developing in a few minutes (about 5 minutes) after the start of inhalation. The pentran accumulates in the body, its removal slowed down.

Fluorotan Easily penetrates through a placental barrier, inhibits the contractile ability of the uterus, negatively affects the state of the fetus and the newborn. In this regard, it can be used only in low concentrations up to 0.5 percent by volume and by special indications (concomitant bronchial asthma, pronounced arterial hypertension).

Non-campaign anesthetics.

The rate of penetration of non-campaign anesthetics through the placenta is depending on the molecular weight (which it is lower, the faster penetration), fat-solventness and metabolic rate. When prescribing a standard dose of a drug or analgesic designed for 1 kg of body weight, the individual reaction is also determined by such factors as hypovolemia, hypoproteinemia that increase the concentration of these substances and their circulation in an unrelated state.

A certain influence on the penetration of narcotic drugs to the fetus has the nature of the contractile activity of the uterus. Thus, with the turbulent generic activity, the reduction of myometrium can completely stop the blood flow in the intervalistic space, therefore, the admission of drugs will cease. Great importance It also has the degree of maturity of the fetus. With the immaturity of the fetus, against the background of standard doses, there is a pronounced depression of both the fetus and the newborn.

Barbiturates (hexenal, thiopental sodium, etopal sodium, barbamil, etc.). Apply as sedative and sleeping pills, as well as for a short-term anesthesia. The dose causing a sedative effect is 0.030-0.060 g, sleeping pills - 0,100-0,200 g. Barbiturates, being weak acids and having a low molecular weight, quickly penetrate through a placental barrier. With intravenous administration of them at a dose of 4 mg / kg of body weight, they do not have a pronounced depression on mature docking newborns. The side effects of barbiturates include hypotension, respiratory oppression. During childbirth, these drugs are rarely prescribed. The main indication for their use is to obtain a quick sedative and anticonvulsant effect in pregnant women with severe forms of gestosis, as well as protecting the brain when stopping cardiac activity.

Derived phenothiazin It is often prescribed during childbirth as tranquilizers, or atractic agents that eliminate the feeling of fear. Reducing the alarm state, they do not cause drowsiness. In addition, the derivatives of phenothiazine have antiemetic and antihistamine action. The combined purpose of them with narcotic drugs or analgesics allows you to reduce the dose of the latter. The most commonly used diprage, which is prescribed at a dose of 0.025-0.050. This dose does not cause oppression of breathing, does not suppress the cutting activity of the uterus, causes a slight depression from the fetus and a newborn.

Benzodiazepine derivatives use Sibazon (diazepam). The drug does not have an anesthetic effect, therefore it is prescribed in combination with narcotic or non-nucleic analgesics. Sibazone is administered intramuscularly at a dose of 0.020-0.040 g, intravenously at a dose of 0.005-0.010, when it is equipped with eclampsic seizures, it is used as an effective anticonvulsant preparation. When intravenous administration, after 10 minutes, the drug is determined in the blood of the fetus, it is circulating in the blood of a newborn, causing narcotic depression.

Droperidol - Neuroleptic, causes the condition of neuroleppia (calm, indifference and alienation), has a strong anti-anemic effect. In obstetric practice, he received significant distribution. However, it should be remembered about the side effects of the Droperidol: it causes extrapyramidal symptoms in the mother, inhibition of breathing and hypotension in a newborn. During the birth, the droperidol is injected intramuscularly in a standard dose of 0.005-0,010 in the accompanying arterial hypertension or pre-pretext raroperidol combined with analgesics.

Narcotic analgesics.

Morphine Used as a tocolithic means in the discordination of generic activities. The drug has a pronounced sedative and sleeping pills, however side effects They manifest themselves in the form of oppression of breathing in the mother and the newborn, as well as the development of nausea and vomiting in the guinea. Morphine is not recommended to enter later than 3 hours before the expected birth of a child. Standard dose 0.010

As narcotic analgesics use obanopon at a dose of 0.020 g, promedol In a dose of 0.020 g, the side effects of which are less pronounced than the previously used morphine.

The group of non-scientific analgesics includes pentazocin (Forral) - Synthetic analgesic. When used to the drug, addiction is not developing, nausea and vomiting rarely occurs. During the birth, a dose of 0.040 g is usually applied, which has a significant painkillers. Perhaps the oppression of breathing both in the mother and in the newborn.

Fentanyl - Strong, but short-range analgesic. Its anesthetic effect is 100 times superior to such morphine. The maximum anesthetic effect occurs after 1-2 minutes after intravenous and 10-20 minutes after intramuscular administration; The duration of action does not exceed 30 minutes. Fentanyl depresses his breath, can cause apnea and sharp bradycardia. Apply no later than 2 hours before the birth of a child.

In addition to the above preparations, 50% analgin solution introduced in a dose of 1-2 g, both intramuscularly and intravenously, can be used for pain relief in genera. To potentiate the effect combined with antispasmodic and antihistamine preparations.

Prepanidide (Somubrevin) Used for anesthesia at small obstetric operations (Overlaying obstetric forceps, manual selection of the last and a cavity examination postpartum uterus, stitching deep breaks). It is administered intravenously at a dose of 5-15 mg / kg body weight.

Sodium Oxibutirate (GOM) It is used for anesthesia during childbirth as a base agent if you need to leisure a rest. As a rule, the minimum dose of the preparation of 60-75 mg / kg of body weight is used. Sleep occurs after 10-15 minutes, anesthesia - in 15-30 minutes. Duration of anesthesia - 40-120 minutes, sleep lasts 2-5 hours.

Kethamine (Ketalar, Calipasol) - Powerful anesthetic used intramuscularly and intravenously. The main side effect of this drug is arterial hypertension, therefore, according to many authors, its use is contraindicated in prisons. Ketamine quickly penetrates the placenta even in a dose of 1 mg / kg body weight, causing narcotic depression in a newborn. The dose used for anesthesia is 2 mg / kg body weight. To relieve hallucinogenic action, ketamine is prescribed in combination with small doses of droperidol or sled.

Local and regional anesthesia.

For local anesthesia 0.25-0.5% novocaine solution, 0.5-1% Trimkain solution, 0.25-0.5% Lidocaine solution. These same solutions, but in higher concentrations are used for epidural and spinal anesthesia. Typically, adrenaline is added to the topianessee, which increases the duration of the anesthesia and reduces the likelihood of toxic reactions. When performing epidural anesthesia, these drugs are freely penetrated through the placenta and their concentration in the blood of the fetus is about 70% of the concentration in the blood of the mother. It is known that toxic action topless drugs occur in overdose or erroneous introduction to blood vessel. At the same time, convulsive twitching of mimic muscles appear, then passing into generalized convulsions with loss of consciousness. In the absence of intolerance to local anesthesia, novocaine or lidocaine is applied before performing epizotomy.

Schematic representation of pouded anesthesia

Conceptual image of paravaginal anesthesia

The blockade of floor nerves eliminates the feeling of pain in the crotch and the vagina. This is the most affordable method of anesthesia in the delivery by the overlay of obstetric forceps. The blockade can be performed from two access:

• Transcrome technique. When the blockade through the perineum, the needle is at least 10 cm in length, corresponding to the middle of the distance between the sedlicate hill and the edge of the external sphincter of the rectum, and are carried out for the sedable residue. Making advantage of the absence of blood in the syringe (sexary artery is located close to the injection site), 10 ml of 0.5% of the novocaine solution is introduced.

  Applying this method of anesthesia, it is necessary to bear in mind that in some women the type of innervation is concentrated, and others have scattering. But since external signs It is impossible to determine the type of innervation, it is impossible to introduce anesthetic to a fan-shaped across the entire sedlicate-recycling tissue.

  Considering that the external genital organs and the crotch are sometimes innervated by not only an intense nerve, but also a iliac-inguinal nerve, an anesthetic should be administered and in the region of the Lonnaya Buggray, where the twig of this nerve passes. Anesthesia bilateral. In each side, 50.0-100.0 ml of 0.25-0.5% novocaine solution is introduced.

  Additionally block the crotch branch of the rear skin nerve of the hip with an introduction on each side with 5 ml of anesthetic at the outer surface of the sedlicate beast.

  With episiotomy, infiltrate the tissue anesthetic along the line of the future section.

• Transvaginal technique. When the blockade, the vagina pierces its wall at the level of the sedlicate asset and the end of the needle is located directly behind it. Then the blockade of the floor nerve and infiltrate the crotch fabrics. The procedure is performed on both sides. The sign of the effectiveness of the blockade of sex nerves is the lack of reducing the external sphincter of the rectum when touched it.

The advantages of none of the ways of poucher anesthesia do not have. A good painkiller effect is observed in 50-60% of observations. Possible complications: general oxic reactions when entering a local anesthetic to a vessel or with its overdose, hematoma, infection.

Paracervical blockade. Used as a type of regional anesthesia only in the first period of birth. The blockade begin when the cervix disclosure is 5-7 cm and regular painful contractions of the uterus. The anesthetic solution is introduced into paracervical fabrics at the base of a wide bunch of uterus. Care should be taken to not punish the uterine artery. When using a 1% novel solution of 5 ml on each side, the anesthesia continues for 60 minutes. Complications may be observed in the form of bradycardia by the fetus.

Epidural anesthesia. In obstetrics, both lumban and caudal epidural anesthesia are used. Anesthesia can be disposable or extended. In this case, the peridural space is introduced a permanent catheter, into which the solution is injected for local anesthesia. Epidural anesthesia can be used both for kindness of childbirth and with all types of operational delivery. Detailed information about the features of epidural anesthesia can be found in the works of N.N. Rasstigar (1978), V.V. Abramchenko and E.A. Lanceva (1985), D.D. Moir (1985).

Total spinal anesthesia. Typically produce a single injection of a hyper-permissive solution of local anesthetic, which prevents the penetration of this solution upwards, along the spinal cord channel. The spinal anesthesia is produced during the overlapping of obstetric tongs and caesarean sections. In the spinal anesthesia, the sudden development of deep arterial hypotension is possible, as a result of which anesthesia is recommended to be performed after preliminary hypervolemic hemodilution. The anesthesia at the same time anesthesia is achieved very quickly, so it is preferred to produce on emergency testimony.

Despite the continuous development of medicine, anesthesia in childbirth is still not a mandatory procedure. Much depends on the peculiarities of the painful threshold: if it can transfer natural delivery without the use of painkillers - they are not used if there is no readings for this. Much less often in childbirth general anesthesia Preparations, immersing a person in a deep sleep, but they are unsafe for the child, so it is most often recommended to resort to spinal or epidural anesthesia.

Many women during pregnancy are interested in pain relief issues during childbirth, since it is no secret that the process is always associated with pain that can be long and unbearable. They ask questions to the doctor: is it possible to give birth without the use of anesthesia methods and what is better - epidural anesthesia or common anesthesia? Modern methods of anesthesia are considered conditionally safe both for the mother and for her child, and make birth more comfortable for a woman.

Types of anesthesia in natural childbirth

There are non-drug (natural) and drug anesthesia methods. Natural methods are completely safe and effective. These include: respiratory technique, massage, acupuncture, aromatherapy, relaxation, etc. If their use did not bring the result, resort to the help of drug anesthesia.

To methods medicinal anesthesia relate:

• epidural anesthesia;
• spinal anesthesia;
• local anesthesia;
• inhalation anesthesia;
• general anesthesia.

In natural breeds, it is resorted to the use of epidural and spinal anesthesia.

Epidural anesthesia

Epidural anesthesia highly eliminates sensitivity at the bottom of the body of the woman in labor, but at the same time it does not affect her consciousness. The type of birth, on which the doctor resorts to epidural anesthesia, varies from different patients depending on their pain.

In epidural anesthesia, anesthesiologist and an obstetrician assesses the state of the mother and until the child who has not yet born, and also turn to an aenesis on conducting anesthesia in the past and flow of previous births, if any.

In epidural anesthesia, the drug is introduced into the spinal space in which the nerve roots are localized. That is, the procedure is based on the blockade of nerves. This type of anesthesia is usually applied with a natural delivery in order to facilitate the fighting process.

Execution technique:

• a woman takes the "Embry" pose, the maximum flexing his back;
• the area of \u200b\u200badministration is processed by an antiseptic agent;
• the area of \u200b\u200bthe spine is injected with an anesthetic drug;
• after the medicine begins to act, the pussy is carried out by a thick needle in epidural space, while the anesthesiologist does not feel solid cerebral shells;
• after that, the catheter is introduced through which anesthetics will come to the body;
• the needle is extracted, the catheter is fixed using adhesive tape on the back and it takes a test injection of the drug, during which the doctor carefully monitors the state of a woman;
• for a while, the woman should be in the lying position to avoid complications. The catheter remains in the back until the end of childbirth, it will be possible to introduce a new portion of the medicine periodically.

The catheterization procedure itself takes no more than 10 minutes, while the woman must maintain the most fixed state. The drug begins to effect about 20 minutes after the introduction. For epidural anesthesia, drugs are used that do not penetrate a placental barrier and cannot harm the child: lidocaine, bupivacaines and novocaine.

Indications for epidural anesthesia:

• kidney disease;
• myopia;
• young age of a future mother;
• low pain threshold;
• premature generic activities;
• misconception of the fetus;
• heavy somatic diseases, for example: diabetes mellitus.

Contraindications:

• heart disease and vessels;
• unsatisfactory blood coagulation;
• injury and deformation of the spine;
• high risk of uterine bleeding;
• inflammatory phenomena in the field of puncture;
• increased intracranial pressure;
• reduced blood pressure.

Positive sides:

• a woman can relatively freely move during childbirth;
• state of cardio-vascular system more stable unlike common anesthesia;
• anesthesia practically does not affect the fetus;
• the catheter is introduced once for an indefinite period, so if necessary, the drugs can be administered during the desired period of time;
• woman will see and hear her child immediately after appearing on the light.

Negative sides:

• the likelihood of an inadequate result of anesthesia (5% of women does not achieve the effect of the introduction of anesthetic);
• complex catheterization procedure;
• the risk of intravascular administration of the drug, which is fraught with the development of convulsive syndrome, which is even rare, but may cause the death of the guide;
• the drug begins to act only after 20 minutes, therefore, with rapid and emergency birth, the use of epidural anesthesia is not possible;
• if the drug is introduced through cellic shellThe spinal block is developing, a woman needs urgent resuscitation.

Spinal anesthesia

Spinal anesthesia, like epidural, is performed almost the same, but with the help of a thinner needle. The difference in the spinal from epidural anesthesia is as follows: the number of anesthetic for the spinal block is substantially smaller, and it is introduced below the border of the spinal cord into the space where the spinal fluid is localized. The feeling of anesthesia after the injection of the drug comes almost immediately.

Anesthetic Through a thin needle is introduced once in the spinal cord channel. Pain impulses are blocked and do not go to the centers of the brain. The proper result of anesthesia begins after 5 minutes after the injection and continues for 2-4 hours, depending on the selected drug.

During the spinal anesthesia, the Hife also remains conscious. She sees her child immediately after birth and can attach it to his chest. The spinal anesthesia procedure requires mandatory venous catheterization. Through the catheter in the blood of a woman will receive saline.

Indications for spinal anesthesia:

• gestosis;
• kidney disease;
• diseases of the broncho-pulmonary system;
• heart defects;
• high degree of myopia on the background of partial retinal detachment;
• improper preservation of the fetus.

Contraindications:

• inflammatory process in the zone of the alleged puncture;
• sepsis;
• hemorrhagic shock, hypovolemia;
• coagulopathy;
• late toxicosis, eclampsia;
• acute pathologies of the central nervous system of non-infectious and infectious origin;
• allergy to local anesthesia.

Positive sides:

• 100% guarantee of anesthetic;
• the difference between the spinal anesthesia from epidural implies the use of a thinner needle, so the manipulation of the administration of the drug is not accompanied by severe painful sensations;
• drugs do not affect the state of the fetus;
• the muscular system of the feminine is relaxing, which helps the work of specialists;
• a woman is in full consciousness, so she sees her child immediately after birth;
• there is no probability of systemic influence of anesthetic;
• spinal anesthesia at cost is cheaper epidural;
• the technique of administration of anesthetic is more simplified compared to epidural anesthesia;
• fast resulting effect of anesthesia: 5 minutes after the administration of the drug.

Negative sides:

• the effect of anesthesia is undesirable to extend longer than 2-4 hours;
• after anesthesia, the woman should be in a lying position for at least 24 hours;
• after puncture, headaches often occur;
• a few months after the puncture may be observed back pain;
• the rapid effect of anesthesia is reflected in arterial pressure, provoking the development of cutting hypotension.

Effects

The use of anesthesia during childbirth may cause short-term consequences in a newborn, for example: drowsiness, weakness, oppression of the respiratory function, the unwillingness to take the chest. But these consequences are quite quickly passing, as the drug used for anesthesia is gradually leaving the child's body. Thus, the consequences of drug painting of generic activity are caused by the penetration of anesthesia preparations through the placenta to the fetus.

It should be understood that anesthesia blocks pain, but this effect does not do without unpleasant consequences. For the guinea, the introduction of anesthetics into the body is reflected on the activity of the uterus, that is, the process of natural cutting of the cervix becomes slowed. This means that the duration of childbirth may increase.

The reduced activity of the uterus is that the fights are oppressed and may stop at all. In this case, experts will be forced to enter in the body of the women in labor medication tools To stimulate the generic process, in some cases - use obstetric tongs or carry out a cesarean section.

Also, after using anesthesia during childbirth, such side effects often develop as headache, dizziness, gravity in the limbs. In the epidural and spinal anesthesia, blood pressure is reduced. In general, the effect of anesthesia is achieved successfully with all types of anesthesia, but it may be preserved a sense of pressure at the bottom of the abdomen.

In developed countries, more than 70% of women are resorted to pain relief in childbirth. Increasingly, women insist on carrying out pain relief in childbirth, to minimize soreness of kits, despite the fact that childbirth is a natural process that can pass without outside interference. During natural genera, the body produces the impact number of endorphins - hormones that provide physiological anesthesia, contribute to the emotional rise, reduce the feeling of pain and fear.

Useful video about epidural anesthesia in childbirth

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It is very important from the very beginning of pregnancy to begin psychological preparations for childbirth, tune in for a prosperous outcome. A physician who observes your pregnancy may have great help in this, of course, if there is a complete mutual understanding between you. Ideally, when the same doctor also behaves childbirth. During the pregnancy, you become members of the same team, and during childbirth will enjoy powerful psychological support.

Types of anesthesia

Most often applied:

• promedol (narcotic substance that is introduced intravenously or intramuscularly)
• epidural anesthesia (an anesthetic substance is introduced into the space in front of a solid cerebral shell surrounding the spinal cord)

Does the anesthestics affect the child

Promedol in the dose that is used for childhood anesthesia does not adversely affect the fruit. However, the child can sleep together with her mother.

Epidural anesthesia is considered extremely necessary for the maintenance of childbirth, it makes childbirth less traumatic for the fetus, since the main obstacle that meets the fetus head when promoting, neck of the uterus, significantly softens and opens faster.

What is better: Promedol or Epidural Anesthesia

It depends on many circumstances that only the doctor can evaluate.

But it should be borne in mind that Promedol can only be introduced once, so it is better to introduce it when the strong contractions and the cervix well opened, since the action continues 1-1.5 hours. Completely pain Promedol does not remove, but significantly reduces the sharpness of pain, it is perceived differently.

And when performing epidural anesthesia, the pain is completely removed, the anesthesia can be added through a thin catheter as the pain enhanced.

Epidural anesthesia makes only very experienced anesthesiologists, perfectly owning this technique, therefore such a complication, as the injury of the spinal cord, is practically excluded. Rare, but encountered, complication is a headache after childbirth, which is very soon.

Minuses

Of course, epidural anesthesia has their pitfalls. First of all, this method of anesthesia is not suitable for everyone. Contraindications include: Allergic reactions to local anesthetics (preparations used in the treatment of teeth: Lidocaine - as a local painkillers it is flawless, Novocaine, etc.), poor blood clotting, increased temperature, neurological diseases, bleeding, obesity, purulent wounds In the area of \u200b\u200bthe belt. Of course, no one makes anesthesia before establishing regular generic activities and if the woman refuses her, preferring courageously to endure pain. How long to tolerate and when to turn to professional assistance, every woman decides herself. In principle, many women can manage without painkillers. Someone turns out to be a high pain threshold and even the first births pass easily and quickly. If it turns out to be tolerated - it is better, of course, pull out, the anesthesiologists understand this. It would be a mistake to compare epidural anesthesia with a mint candy that will be suitable for everyone without exception and knowingly safely. This method also has side effects and complications. The most common complication is a headache that can hold up to three weeks. This is the consequence of an unintentional puncture of a solid cerebral shell, when the needle enters the vertebral a little further than. This happens even with experienced specialists in 1% of cases in the world. These pains are well treatable and pass without consequences. Another problem is a decrease in blood pressure. For the prevention of this complication before anesthesia, about 500 ml of liquid is introduced into the vein for 5 minutes. It rarely, but it happens that the highly concentrated solution of local anesthetic slows down the generation process. Among other side effects are leading pain in the injection site (can hold up to seven days) and allergic reactions. Some confuse that the use of epidural anesthesia deprives the feminine opportunities to move independently. However, many of these minuses still overlap with one big plus: women who gave birth without wild pain often leave the maternity hospital with the intention to give birth in the same place, and maybe the third child.

Ultimately, give birth with anesthesia or without it - a personal decision of a woman. The main thing is that it is made reasonable and honest. No matter how much childbirth goes, with knowing that you have a ku yes to retreat that in no case you will not leave you, not with an unbearable pain, - in itself a very powerful soothing factor that many allows you to do without the help of aneles of thenese .

Fear in front of childbirth (especially first in life) - the phenomenon is standard. But they are afraid, as a rule, not the births themselves, but the pain that the girl is experiencing at this time. Yes, childbirth proceed different people differently. Some say that everything passes almost painlessly, while others - that, the pain is simply unbearable. Here a lot depends on the characteristics of the body of the woman in labor. In this article, we will consider in detail the anesthesia during childbirth, its types, testimony and contraindications. Information will be useful for those who are going to give birth to a child, but fears precisely by pain and does not know what methods of anesthesia today exist.

Basic methods of pain relief during childbirth

In modern obstetric practice there are several effective ways of anesthesia. At the moment, epidural anesthesia is considered optimal, which allows to completely eliminate pain in the first period of childbirth - when the cervix is \u200b\u200brevealed. In most cases, this is the most painful for a woman. And often the longest. Epidural anesthesia during natural childbirth makes this process painless. The essence of the procedure is reduced to the fact that the solution of local anesthetic is introduced into the space above the shell of the spinal cord. After the injection of the pair of minutes, the entire bottom of the body becomes insensitive. The signal from the brain is blocked and the woman does not experience pain. The advantage of epidural anesthesia is that, unlike common anesthesia, a woman remains conscious.

2. Inhalation anesthesia during childbirth

Less radical, but not so effective is inhalation anesthesia. It is a general anesthesia using nitrogen overhangs, which is fed into lightweights through a special mask. Such anesthesia is applied at the first stage of childbirth, as well as the previous way.

3. Local pain relief during childbirth

Its essence comes down to the fact that only some parts of the body are anesthetically. Thus, the guinea still remains in the consciousness of the whole period of childbirth.

4. Narcotic analgesics during childbirth

These drugs can be administered both intramuscularly and intravenously. Under their influence, the sensitivity to pain is reduced during childbirth, the female can be more relaxed between the fights.

This is not a complete list of methods of anesthesia in natural childbirth without cesarean sections. However, obstetrics and gynecologists recognize them the most rational and safe for the mother and the child. In any case, the method of anesthetic is assigned individually in each particular case by the attending physician.

Methods of anesthesia during childbirth with a cesarean cross section

Conducting cesarean sections during childbirth - a frequent necessity. In this case, several types of anesthesia are applied. And in some cases, the fever can choose which method to use. However, the specialists of obstetrics and gynecology strongly recommend two types:

· Epidural anesthesia;

· General anesthesia.

What depends on the choice of anesthesia during childbirth

Answer is definitely, what anesthesia is better with a cesarean section, it is impossible. There are three main factors, depending on which the anesthetic method should be selected:

1. Psychological preparedness for the operation. A woman can choose that it is preferable for her: to sleep during childbirth or remain in consciousness to see his newborn baby immediately.

2. Equipment level of the hospitalwhere operations will be performed. It may be that the chosen hospital is not equipped with the necessary equipment for performing certain types of anesthesia.

3. Qualification of specialistsHaving generated childbirth. First of all, this applies to anesthesiologist and whether it really will be equally qualitatively able to carry out any of the anesthesia methods.

Consider both types of anesthesia in more detail and decide which anesthesia is better at cesarean section.

Anesthesia is performed by using three components: "Preliminary anesthesia", the introduction through the trachea tube and the supply of augal gas with oxygen, the introduction of Miorosanta. Only after all three steps are made, you can start an operation.

The advantage of the general anesthesia is that the feminine is tightly sleeping during all stages of the operation and does not feel pain. In addition, there are almost no contraindications to it. But at the same time, quite serious side effects and complications may occur.

Complications from general anesthesia during childbirth

· Headaches, dizziness, nausea and unpleasant muscle weakness.

· Allergic reactions, infection of respiratory tract, pneumonia in particularly critical cases.

Among other things, general anesthesia can influence the child:

· Sleepiness and general weakness;
· Temporary breathing problems;
· Perinatal encyfalopathy.

Similar negative consequences It is not often found, but they can take place. But before you give up the general anesthesia, please note that today are designed effective techniquesHelping the child normally move the effects of anesthesia.

The principle of conduct is practically no different from the above described above, so we will not again describe it in detail again. Let us dwell on the details that are not mentioned. Preparation for anesthesia begins on average for half an hour before the operation. After anesthesia works, the specialists are proceeding directly to the execution of cesarean sections.

Despite the fact that epidural anesthesia is considered one of the most gentle and secure methods anesthesia Contraindications for her everything is just like that:

· The presence of skin inflammations or gunnings, which are within a radius of 10 cm from the place of the puncture;

· Problems with blood clotting;

· Allergic reactions to some of the preparations used;

· The diseases of the spine and osteochondrosis, which is accompanied by severe pain;

· Improper position of the fetus;

· Too. narrow pelvis or great weight of the fetus.

Side effects are also possible. However, if we are talking about a cesarean section, then with epidural anesthesia, their risk is significantly higher, with anesthesia with natural childbirth. The fact is that the operation is introduced more drugs. Including narcotic substances, among which fentanyl.

However, if an anesthesiologist is experiencing and has high qualifications, then complications are minimized in most cases. However, even in this case, certain unpleasant sensations after the operation may occur.

The consequences of epidural anesthesia

· Shivering in the legs, scalp and back pain. Often, all these consequences are completely disappearing a few hours after the operation, but headache in rare cases is stretched for several days, and sometimes even up to several months.

· Problems with urination. Rare side effect - allergic. And almost always at the disposal of specialists there is everything necessary to eliminate such effects.

· Nerva injury or spinal cord. An extremely rare phenomenon that takes place only when working a non-professional or inexperienced anesthesiologist.

It should also be remembered that in the epidural anesthesia, a woman has no legs. Many scares and cause strong discomfort.

Testimony for anesthesia during childbirth

As in the case of natural genus, and with childbirth through caesarean section, there are a number of indications for anesthesia:

· Strong pain During the bouts of the woman in labor. On average, about 25% of the feminines are experiencing significant pain when anesthesia is sharply needed. About 65% experience medium pains, and approximately 10% feel only minor pain sensations;

· Too. big size fetus, since its output can provoke serious pain;

· Too long time of childbirth;

· Weak generic activity;

· Always when conducting cesarean sections;

· In the hypoxia of the fetus. In this case, anesthesia is one of the most effective techniques reduce the risk of its manifestation;

· Necessity surgical intervention in the process of childbirth. In this case, intravenous anesthesia is mainly used.

Promedol anesthesia for childbirth

Anesthesia in kinds of Promedol is one of the most sought-after methods. However, it should be remembered that Promedol is a narcotic substance. Promedol is introduced into a vein or muscle. In most cases, injection allows you to break from pain from half an hour to two hours. Sometimes it is possible to sleep normally. It all depends on the reaction of the body to the effects of the drug. Therefore, some feminine sleep well until the birth of the baby, while others manage to take a short time. Top border The effects of the drug sometimes reaches two hours from the date of birth.

Injection After the cervix is \u200b\u200brevealed by more than 8 cm, it is not performed, since the child must independently do the first breath. Accordingly, it should be cheerful, which is impossible if the drug also affects it. It is also not recommended to use Promedol before the cervix will reveal at least up to 4 centimeters. If you make an injection before the cervix opens, it can become the main reason Generic weakness. In addition to directly anesthetic action, Promedol can be used to treat all sorts of pathologies of generic activity. It should be remembered that the drug may have a number of contraindications:

· Individual intolerance;

· If there is an oppression of the respiratory center;

· The presence of a blood coagulation disorders;

· Simultaneously with the reception of Mao inhibitors for the treatment of CNS diseases;

· high blood pressure;

· bronchial asthma;

· Infertility nervous system;

· Heart rhythm violations.

Promedol with childbirth consequences for a child and mother can be exercised in complications:

· Nausea and vomiting;
· Weakness;
· The confusion of consciousness;
· Weakening of body reflexes;
· Disruption of the child's respiratory function.

In this regard, it is necessary to weigh all the "for" and "against" the use of Promedol before making a choice in favor of the drug.

Modern methods and techniques of childbing, as you could already understand, differ. However, there is no urgent need for drug pain relief. In some cases, it is quite enough to perform some effects without drugs to ensure a decrease in pain in the female restaurant. Consider the main of them.

Types of natural anesthesia in childbirth

1. Anesthetic massage. A specialist in the process of massage is affected by the surface of the body and nerves, while causing minor pain. At the same time, attention is distracted from generic pains. In most cases, massage consists in stroking the back and the collar zone.

2. Relaxation. Not always even requires the impact of a specialist to weaken the pain. There are a number of relaxation methods that are able to reduce the level of pain and provide a full-fledged rest in the interruptions between them.

3. Hydrotherapy. Birth in water, in which pains are noticeably reduced, and the births themselves occur markedly faster. You can use both the shower and the bathroom during the bout.

4. Electric analysis. In this case, an electrical current is used that affects key biologically active points and allows you to better transfer generic pain.

5. Fitball. Fitball makes it easier to carry the contractions, you can sit on it or lie.

Additional types of anesthesia

Spinal anesthesia - a single injection using local anesthetic. The duration of action is from 1 to 4 hours depending on the selected anesthetic and features of the body of the manufacturer;

Combined technique - combines the best sides of the spinal and epidural anesthesia. This method Anesthesiologist is prescribed;

Regional anesthesia - anesthesia of individual sites. One of the most efficient, safe and comfortable ways.

Each woman in labor has the right to choose the most suitable method of anesthesia. However, the final decision is made jointly with the attending physician. To achieve the desired result and complete pain relief in each case, you need to choose different methods. Otherwise, there may be negative consequences for the mother and child, as well as pain. Therefore, regardless of what kind of childbirth, an approach to choosing an anesthetic should be responsible and weighted.