Why general anesthesia is not desirable for caesarean. Which anesthesia is better for caesarean section: types, indications, contraindications, reviews

The date: 18.04.2019

Caesarean section is classified as a surgical intervention with a low potential for postoperative consequences. As a rule, the trigger for complications after caesarean section is the reason that made you resort to this type of delivery. For example, placental abruption prompts the doctor to perform emergency surgery. At the same time, problems arising in postoperative period, primarily due to early placental abruption. Most often, the urgency of the situation does not allow performing either spinal anesthesia (complexity of procedures), therefore, general anesthesia is usually performed, in which the incidence of complications is much higher.

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Risk factors

If a caesarean section is performed, complications after the operation can be triggered by a number of factors:

obesity;
large size of the fetus;
complications that led to the need for surgery;
prolonged labor or surgical intervention;
history of several births;
allergies to latex, anesthetics and other drugs;
limited physical activity mothers during the period of gestation;
low blood cell count in a woman;
the use of epidural anesthesia;
premature birth.

What are the most common complications

The following complications may occur during surgery or in the postoperative period:

infectious;
excessive blood loss;
damage to internal organs;
the need for a hysterectomy (removal of the uterus);
thrombus formation;
reaction to medicines;
neurological problems (consequences of anesthesia with caesarean section);
tissue scarring and possible problem with subsequent childbirth;
mother's death;
child trauma.

Fortunately, serious complications from caesarean section are rare. Although maternal mortality in this operation is higher than in women with vaginal delivery. Since the reasons for which this surgical intervention is performed are quite often potentially life-threatening for the mother.

Infectious complications

The operation itself, as a result of which the abdominal wall and membranes of the uterus are dissected, causes bacteria (usually non-pathogenic from the vagina) to enter the wound surface. This can lead to the development of various infectious complications in the postoperative period.

Suppuration of the postoperative wound

Sometimes the reproduction of bacteria does not occur in the uterus, in abdominal wall. Infectious inflammation of the skin and underlying tissues, which are applied, can lead to the formation of abscesses and purulent swells, which will require a second operation. But, as a rule, these complications are recognized on initial stages when treatment with antibiotics is possible.

Fever, pain and redness in the area postoperative wound are the most common symptoms associated with this problem.

Postpartum fever and sepsis

According to some reports, 8% of women in the postoperative period may develop the so-called puerperal fever or puerperal fever. Usually, the complication begins with inflammation of the uterus or vagina, then bacterial infection spreads throughout the body, affects the lungs (occurs after a caesarean section) and other organs.

When microbes are found in the blood, this process is called sepsis. This is a pathology that requires long-term antibiotic treatment, which is considered the most dangerous complication, sometimes leading to death. Fever during the first 10 days after is a sign of puerperal fever. Timely initiation of treatment can prevent the further development of this severe complication.

Bleeding

With natural delivery, the average blood loss does not exceed 500 milliliters, during a caesarean section, it can reach 1 liter. In most cases, such blood loss is tolerated by women who do not have comorbidities, without any difficulty. However, sometimes serious bleeding occurs, which can occur during or after surgery.

Postoperative bleeding

Blood loss up to 1 liter during caesarean section - this can be considered the norm. Bleeding can also occur after surgery, which is usually associated with clotting problems. This is an urgent situation, so if a woman notices an outflow from a wound, you should immediately contact your doctor.

After the bleeding has stopped, it is usually required recovery period within a few weeks. Sometimes blood is transfused intravenously, blood substitutes, iron preparations, vitamins are prescribed.

Atony

After removal of the baby and placenta, the uterus usually contracts, which leads to the closure of the gaping blood vessels. When this does not happen (a condition called uterine atony), prolonged bleeding is possible. Fortunately, in the arsenal of doctors there are very effective drugs to help combat this problem. Most of them contain prostaglandins. To date, delayed complications associated with uterine atony are extremely rare.

Tears, damage to internal organs

There are cases when the incision is not large enough to remove the child without tearing the tissues of the uterus. To the right and left of it are large arteries and veins, which in this situation can be damaged and bleed. As a rule, the operating surgeon notices this in time, preventing the woman from losing a lot of blood. Sometimes he can damage nearby organs with a scalpel. Injury Bladder leads to serious bleeding and, as a rule, requires suturing its wall.

Dense attachment and accreta of the placenta

When a tiny embryo moves into the uterus, cells called trophoblasts accumulate on its wall (the villi of the placenta form from them). They penetrate the wall of the uterus in search of blood vessels. These cells play an important role in the movement of oxygen and nutrients from the mother to the fetus. The fibrous layer of the uterus prevents the deep penetration of the villi of the placenta into its wall. If this layer was previously damaged (for example, any operation on the uterus), then a condition called placental accreta may develop, sometimes even penetration of trophoblasts into the bladder occurs.

The danger of this problem is that serious bleeding may occur. The good news is that doctors today have learned to recognize this formidable complication in a timely manner and quickly take appropriate measures. The bad news is that a problem almost always requires a hysterectomy.

Hysterectomy

Removal of the uterus is sometimes done immediately after a caesarean section. Some complications (usually associated with bleeding) force the surgeon to perform this operation in order to save the mother's life. Women who have had a hysterectomy can no longer have children. In addition to this terrible situation, as a rule, this operation does not have any additional problems.

Blood clots or vascular thrombosis

One of the most dangerous complications after caesarean section - the formation of blood clots in the vessels of the legs or pelvic region. Thrombosis of the veins can lead to the separation of a blood clot and its movement to the lungs, the appearance of the so-called embolism. pulmonary artery. Complication, which is the leading cause of death in the postoperative period. Fortunately, the appearance of blood clots in the legs is also manifested by pain in them, which makes a woman see a doctor with this symptom. Timely administration of appropriate treatment (eg, Coumadin or warfarin) effectively prevents the development of pulmonary embolism.

Reactions to drugs, latex, anesthesia

In addition to the risks associated directly with the operation itself, there are complications that a woman can experience when using drugs, latex or anesthesia. Adverse drug reactions can range from mild (eg, headache or dry mouth) to very serious (such as death from anaphylactic shock). The high prevalence of these problems during caesarean section is explained by the urgency of the situation: there is not enough time to conduct allergy tests and evaluate possible reaction during drug interactions.

In the case of a planned operation, they also occur, but much less frequently, and there are practically no serious reactions. Sometimes the mother does not know that she has an allergy to drugs, there are adverse reactions associated with anesthesia. These include:

severe headache;
visual impairment;
vomiting or nausea;
pain in the abdomen or legs;
fever
swelling of the throat;
pronounced weakness;
pale skin;
the appearance of a rash or swelling on the skin;
or fainting;
labored breathing;
weak and rapid pulse.

Majority side effects disappears after discontinuation of the drug. Serious allergic reactions, but they are usually dealt with effectively with drug therapy. Women who have serious adverse drug reactions need immediate medical attention.

Complications and long-term consequences of anesthesia

General anesthesia for elective surgery is rarely used, as a rule, it is used in an emergency. Regional anesthesia is divided into spinal and epidural, during which the lower half of the body is anesthetized. The main difference between these types of anesthesia is where the anesthetic is injected: into the epidural or subdural space.

Complications after spinal anesthesia for caesarean section:

Complications in subsequent pregnancies

After performing a caesarean section, a woman may have problems with a subsequent pregnancy, which is associated with the formation of scar tissue along with the excision. Sometimes there are situations of fusion of the wall of the uterus and the bladder, which leads to its damage during subsequent operations on the uterus. Also, women after caesarean section are more likely to experience generic weakness with natural delivery.

Risks from the child

Not only women can experience complications after a caesarean section. There are some risks associated with the fetus in this operation. The following problems may be identified in a child:

Problem	Why does
preterm birth	If the gestational age was calculated incorrectly, then the baby born may be premature.
Breathing problems	Some studies show that these children have an increased risk of developing asthma in adulthood.
Low Apgar scores	This is the result of anesthesia, fetal distress before delivery, or lack of stimulation during labor that is present when the fetus passes through the natural birth canal.
Traumatization with a surgical instrument	Very rarely, the skin of a child is damaged during surgical intervention(on average, 1 case per 100 operations).

A caesarean section, like any major operation, has complications, sometimes quite severe. life threatening both mother and child. Recovery after surgery takes longer than if the delivery took place naturally. However, in order to save the life of the mother or child, one has to resort to this operation. The emergence of new drugs and methods for determining the risks associated with this operation made it possible to maximally secure this type of surgical delivery; today it is actively used in obstetric practice.

During operative delivery, the child is removed through an incision in the uterus and abdominal wall. This method is called a caesarean section. According to statistics in our country, every 8 woman has indications for its implementation. There are several methods of anesthesia performed before the procedure. So, anesthesia for caesarean section can be spinal, epidural, general intravenous and endotracheal.

When choosing a method of anesthesia, several factors are taken into account: the desire of the woman in labor, the presence necessary equipment and staff in the hospital. It also takes into account the health of the woman, especially the course of pregnancy and the birth itself (planned or emergency caesarean section).

Epidural anesthesia for caesarean section is used during elective operations, since its result appears gradually, after 15-30 minutes. The main mechanism of the procedure is that the sensitivity of the nerve roots in the epidural space of the spine is blocked by an anesthetic.

The procedure is often performed in a sitting position, less often - lying on its side. First, the doctor determines the injection site, then the assistant treats the injection area with a sterile solution. After, applied local anesthesia(shot) for painless administration of epidural anesthesia. The doctor draws a sterile solution into one syringe, and an anesthetic into the other.

A special needle with a diameter of 2 mm and a length of about 9 mm is inserted into the intervertebral region. A sterile solution is used to determine when it enters the epidural space. Then a thin tube is inserted into the needle - a catheter, through which the anesthetic is supplied from the second syringe. The needle is removed, the drug supply is completed after the end of the operation.

Epidural anesthesia for caesarean section is indicated if the woman in labor has:

heart or kidney disease;
preeclampsia;
diabetes;
arterial hypertension;
other health problems requiring gentle anesthesia.

Also, this method is used if childbirth began naturally and an anesthetic was already introduced into the epidural space, but then emergency surgical intervention was required.

Epidural anesthesia is not performed if the woman in labor refuses it herself, there is no specialist, equipment or materials for the procedure in the maternity hospital.

This type of anesthesia is contraindicated for women suffering from low blood pressure and insufficient blood clotting, as well as those who have injuries, curvature and other pathologies of the spine. It is impossible to perform epidural anesthesia in case of inflammatory, including infectious, processes at the site of the proposed puncture. Another reason for refusing this type of anesthesia can be oxygen starvation of the fetus.

If a woman undergoes a caesarean section, anesthesia is one of the sources of complications. After epidural anesthesia, trembling in the muscles of the legs, back pain and headache may appear. The latter sometimes lasts up to several months. Consequences for the child are associated with exposure to anesthetic: a violation is possible heart rate and respiration, hypoxia.

All complications are usually manageable. At the same time, epidural anesthesia provides effective pain relief, is safe for the child (compared to other methods), lowers blood pressure, and, therefore, reduces the risk of significant blood loss. The recovery period after such anesthesia is quite short, during the operation it is possible to control the supply of anesthetic.

Among the shortcomings, one can note the complexity of the procedure - a lot depends on the experience of the anesthesiologist, his qualifications. An incorrect puncture can lead to anesthesia of only one half of the body, to infection, toxic poisoning with respiratory arrest and death.

Since the anesthetic begins to act slowly and gradually reduces blood pressure women, the child experiences oxygen starvation. The same feature does not allow the use of epidural anesthesia in emergency cases.

Spinal anesthesia for caesarean section

Spinal anesthesia is performed during planned and emergency surgery, when there is at least 10 minutes left. The steps of the procedure are almost the same as for epidural anesthesia, but the anesthetic is injected into the cerebrospinal fluid and only with a needle (no catheter is used).

Which anesthesia will be chosen for caesarean section is determined by the list of indications and contraindications. Spinal anesthesia is recommended in the same situations as epidural, but due to instant action can be used when emergency operations.

Spinal anesthesia for caesarean section is not performed if the woman refuses this method of anesthesia or there is no appropriate specialist, drugs, equipment for resuscitation in case of complications.

Contraindications:

dehydration;
bleeding;
poor blood clotting, including due to taking anticoagulants;
infections and inflammations (local at the puncture site, general);
allergic reactions to drugs for the procedure;
disorders of the heart and central nervous system;
high intracranial pressure;
on the part of the fetus - a state of hypoxia.

After spinal anesthesia, like any other anesthesia, complications may develop. Most often the rest are manifested:

back and headaches;
lowering blood pressure;
difficulty urinating;
muscle weakness;
decreased sensitivity.

Spinal anesthesia has many advantages, the main of which are the absence of the effect of drugs on the child, a quick result, complete pain relief and muscle relaxation, and a low risk of developing respiratory disorders in a woman in labor. The dose of anesthetic agents is less than with epidural anesthesia, which means that their negative effects are less pronounced.

The procedure itself is simpler, requires less effort from the anesthesiologist, which improves the quality of pain relief and minimizes the risk of complications.

The disadvantages of the method include: a rapid decrease in blood pressure and the difficulty of normalizing it due to the effect of drugs on the child, the inability to prolong the effect of the anesthetic during the operation (in an emergency - transfer to general anesthesia), a high likelihood of neurological complications, especially headaches.

Cesarean section under general anesthesia

General anesthesia for caesarean section is often used in emergencies. Its essence lies in the fact that anesthesia occurs due to intravenous administration anesthetics or the use of an anesthetic mask. In this case, the mother is in a state of sleep. The duration of the procedure depends on the dose and type of drug, it can be from 10 to 70 minutes.

Cesarean section under general anesthesia is indicated if the operation is performed on an emergency basis and there is a threat to the life of the woman in labor or the fetus, spinal and epidural anesthesia are contraindicated, placental accreta, oblique or transverse position of the fetus are detected. This type of anesthesia has practically no contraindications. If possible, it should not be used acute diseases cardiovascular and respiratory systems.

After the general intravenous anesthesia the risk of developing such complications is quite high:

headache;
dizziness;
short-term disorientation in space and time;
confusion;
muscle pain.

It is also possible to suppress brain functions due to the effects of drugs. This type of anesthesia does more harm to the child than the previous two. The drugs have toxic effect on the central nervous system, respiratory disorders, lethargy may appear.

Caesarean section under general anesthesia has positive sides: anesthesia is always complete, the muscles are relaxed, the surgeon has the opportunity to carry out all the necessary manipulations.

The drugs act very quickly, while the work of the heart and blood vessels is not inhibited. If necessary, anesthesia can be strengthened and extended.

General anesthesia faster than other methods leads to hypoxia in the woman in labor. When connecting artificial ventilation lungs sometimes there is an increase in pressure and increased heart rate.

Drugs administered intravenously have a significant effect on the functioning nervous system child. This negatively affects his condition, especially with premature pregnancy, hypoxia and malformations.

Endotracheal anesthesia for caesarean section

With endotracheal anesthesia, an intravenous infusion of a drug is first performed that turns off the consciousness of the woman in labor, and then a tube connected to a ventilator is inserted into the trachea. In addition to oxygen, an inhalation anesthetic is supplied through it, which blocks pain and puts the woman into a deeper sleep.

Often the method is used together with intravenous general anesthesia. This allows you to increase the duration of the procedure and control breathing.

Endotracheal anesthesia is indicated for emergency operations, the presence of contraindications to other methods of anesthesia, a sharp deterioration in the condition of the mother or fetus. The planned method is used when it is known in advance that the caesarean section will be long, with a large number of additional surgical procedures.

Procedure endotracheal anesthesia absolutely contraindicated in acute and subacute inflammatory processes top respiratory tract, bronchitis, pneumonia, hemorrhagic diathesis, acute and chronic infectious diseases(for example, with tuberculosis of the larynx and lungs). In some heart conditions, if possible, this type of anesthesia is abandoned in favor of another.

During an operative delivery, doctors make an incision to remove the baby. abdominal cavity woman and her uterus. modern medicine allows you to do this safely and completely painlessly. If a planned caesarean section is performed, then the woman can choose the method of anesthesia in advance. Anesthesia can be under general anesthesia, spinal and epidural.

Benefits of anesthesia for caesarean section

Nowadays, women are more and more lucky: during a caesarean section, they have the opportunity to be conscious. However, in emergency situations, doctors resort to general anesthesia. A woman is injected into a vein special preparation which promotes medical sleep and turn off her consciousness.

It is important that the drug is administered correctly, only in this way it will work almost instantly and the woman will fall into an unconscious state.

General anesthesia has many benefits. It acts instantly, which is simply necessary if the operation needs to be carried out without delay. Such anesthesia does not affect the coordinated work of the heart and blood vessels.

Benefits of anesthesia:

The muscles of the woman in labor relax, which makes the work of the surgeon more comfortable.
The depth and duration of anesthesia can be controlled.

But you should be aware that general anesthesia can be dangerous for a child. Muscular, respiratory and nervous activity of the child may be depressed. After anesthesia, a woman can leave for a long and difficult time.

Types of anesthesia for caesarean section

Nowadays, there are several types of anesthesia, which allows a woman to determine for herself whether she will be in a conscious or unconscious state during her own operation. To do this, a woman must be physically and psychologically prepared for the operation. Any method of anesthesia must be safe, so the woman in labor must first find out about the equipment of the maternity hospital.

Anesthesia should be carried out by a highly qualified anesthesiologist who strictly follows all the requirements and standards for anesthesia.

It is worth noting that each of the types can adversely affect the well-being of the child. However, local anesthesia is considered more gentle than general anesthesia. After general anesthesia, the mother will be able to see the child only after a while.

Types of anesthesia:

General;
epidural.

Epidural anesthesia is done half an hour before delivery by piercing the skin at the level of the lower back. The needle is placed in the space where the nerve endings are located. spinal cord. It is into them that a catheter is inserted through which the medicine is allowed to act on the body.

Advantages of different types of anesthesia for caesarean section

Modern methods of anesthesia involve the use of regional anesthesia. Anesthesia is carried out on the spot, while the woman in labor remains fully conscious of the epidural and spinal anesthesia contribute to numbness only in the lower body of a woman. Both types of anesthesia are similar, but differ in the depth of insertion of the catheter and the amount of drugs used.

Spinal anesthesia can be performed in a planned and emergency manner, if doctors have at least ten minutes to spare.

Both types of anesthesia lead to instant pain relief. The biggest plus of spinal anesthesia is safety for the child. The woman's muscles relax, which makes the doctor's work more productive.

Benefits of Spinal Anesthesia:

The drugs enter the bloodstream, which reduces the risk of toxic poisoning.
After the woman comes to her senses, she does not feel changes in her general condition.
A woman is consciously present at the birth of her child, she can hug him.

The disadvantage of spinal anesthesia is a too sharp decrease in blood pressure. The drug has a limited time of action, it is administered only before the start of the operation. There may be some neurological changes that can lead to severe headache.

General anesthesia for caesarean: consequences

Today, general anesthesia for caesarean section is rarely done. But sometimes there are situations when you need to act in a matter of seconds. The advantage of general anesthesia is its immediate effect.

However, a woman must understand that the consequences of general anesthesia can adversely affect the child.

In a newborn, muscle activity may be depressed. The negative effect of drugs after a while ceases to act. But in the first minutes after birth, there is a reduced activity of the child, he may not scream right away.

Benefits of general anesthesia:

Instant action.
Complete relaxation of the muscles makes the doctor's work more comfortable.
The depth and duration of anesthesia can be adjusted as needed.

General anesthesia is used if regional techniques cannot be used for some reason. General anesthesia does not affect the functioning of the heart in any way, which makes it safe. General anesthesia does not affect blood pressure. However, many do not accept this type of anesthesia, since you can see the child only a few hours after his birth, and it is extremely difficult to move away from anesthesia.

What kind of anesthesia is done for caesarean section (video)

Modern medicine provides a woman in labor who is going to have a caesarean section with the choice of anesthesia. It can be general and regional. If the situation is urgent and the operation needs to be done immediately, it is better for the woman in labor to do general anesthesia. If there are no contraindications, the woman is given regional anesthesia. It allows the woman in labor to remain conscious. Each type of anesthesia has its own consequences, so it is up to the woman in labor to decide which anesthesia to choose, after consulting with the doctor.

In certain cases, childbirth cannot go naturally, and then an operation is performed - the newborn is removed from the mother's womb through an incision made in the uterus. Without anesthesia, it is impossible, like any other surgical intervention. Therefore, the question of which anesthesia for cesarean section is better is very relevant.

If the operation is planned, the doctor discusses the choice of anesthesia with the patient, offering his options. If you had to cesarean urgently, the doctor makes his own decision. To date, general (including endotracheal) anesthesia and regional (spinal, epidural, spino-epidural) anesthesia are used.

Modern surgeons and anesthesiologists do not welcome, but still sometimes they are forced to do intravenous general anesthesia during caesarean section, which does not have the most favorable effect on the fetus and the woman in labor.

This is an artificially induced inhibition of the central nervous system, which is accompanied by sleep, loss of consciousness and memory, muscle relaxation, a decrease in some reflexes, and the disappearance of pain sensitivity. This condition is a consequence of the introduction of general anesthetics, the doses and combinations of which are individually selected by the anesthesiologist.

Indications

The doctor prescribes a caesarean section under general anesthesia intravenously in the following cases:

there are contraindications to spinal and epidural anesthesia: coagulopathy, acute bleeding, thrombocytopenia;
oblique or transverse position of the fetus;
morbid obesity;
prolapse of the umbilical cord;
placenta accreta;
previous surgery on the spine;
refusal of the woman in labor from regional anesthesia;
emergency caesarean section.

If these indications are available, a caesarean section is performed under intravenous general anesthesia.

Advantages

Despite the fact that most clinics have now abandoned the use of intravenous general anesthesia during caesarean section, it still has a number of advantages. These include:

complete anesthesia;
maximum muscle relaxation, which is very convenient for the surgeon;
fast action of anesthetics, which allows you to perform the operation instantly, when every minute counts;
does not affect cardiac activity;
does not provoke pressure drop;
the doctor constantly controls the depth and duration of anesthesia;
The technique for administering drugs for general anesthesia is extremely simple, medical errors are excluded, and expensive equipment is not required.

Despite all these advantages, intravenous general anesthesia is rarely offered to women in labor who are going to have a caesarean section. Like any other anesthesia, this one has its pros and cons, and the latter are often decisive for refusing this type of anesthesia.

disadvantages

Doctors do not hide the fact that the consequences of general anesthesia intravenously during a cesarean section can be dangerous to the health and even the life of the baby. It is because of this that it is abandoned in favor of spinal or epidural anesthesia.

The obvious disadvantages of this procedure include:

high risk of complications;
respiratory disorders in the baby;
a depressing effect on the nervous system of the fetus, which will be expressed in its excessive lethargy, lethargy, drowsiness, while at such a moment activity is required from it;
aspiration - the release into the trachea of the contents of the stomach;
hypoxia in a woman in labor;
when connected to a ventilator (artificial lung ventilation), a woman in labor may have an increase in pressure and an increase in heart rate.

The risk of health complications in the baby in the future is too great if a caesarean section is performed under intravenous general anesthesia. And this is the main drawback of this type of anesthesia, which crosses out all its positive aspects.

Therefore, doctors dissuade women in labor from this technique and resort to it themselves only in the most urgent cases. So be sure to find out under what kind of anesthesia a caesarean section is performed in the hospital where you will have the operation.

It is interesting! Scientists from the United States have found that the state of a person under anesthesia is more like a coma than sleep.

Endotracheal general anesthesia

General anesthesia also includes endotracheal anesthesia, which is used in the case of a caesarean section. The pain medication enters the cells of the body through a tube that the anesthetist inserts into the windpipe. Most physicians, if a delivery operation cannot be avoided, choose exactly this technique. Her indications are exactly the same as those of general intravenous anesthesia, but there are much more advantages.

pros

Doctors prefer endotracheal general anesthesia during caesarean section for the following reasons:

medicinal product penetrates the placenta more slowly than with its intravenous administration, so the risk of undesirable consequences for the fetus is much less;
the risk of complications for the respiratory and cardiovascular systems is minimized, since the device removes carbon dioxide from the body and supplies the lungs with oxygen;
anesthetics are delivered in a more precise amount, and the dosage medicinal substance can be changed at any time;
the doctor monitors the level of oxygen saturation and the volume of ventilation received by the lungs;
the contents of the stomach cannot enter the lungs.

So when asked which anesthesia is better for cesarean section - intravenous or endotracheal, doctors most often answer unequivocally: the latter option is preferable. Still, this type of general anesthesia has its drawbacks.

Minuses

The organisms of a woman in labor and a baby can react differently to drugs administered through general endotracheal anesthesia. As a result, the consequences of such an operation are sometimes not only unpleasant, but also dangerous to health. Among them:

nausea;
sore throat, muscles;
shiver;
dizziness up to fainting;
weak consciousness;
injuries of the tongue, lips, teeth, throat;
lung infections;
allergy;
anaphylactic shock;
brain damage in both the mother and the baby;
as well as damage to the nerve processes in both.

Even doctors cannot always predict the negative consequences of endotracheal general anesthesia, especially in the context of delivery, when they are responsible for the life of the mother and child. Therefore, in recent times regional types of anesthesia are used for caesarean section, which have a less harmful effect on the fetus: spinal, epidural and spino-epidural.

through the pages of history. In ancient times, during childbirth, electric ramps were used as a kind of anesthesia.

spinal anesthesia

Local (regional) spinal anesthesia for caesarean section provides blocking of all types of sensitivity. In some sources, it may be called spinal. It consists in the fact that the drug is injected through a puncture between the vertebrae into the cerebrospinal fluid. In this case, the needle is inserted much deeper than with epidural anesthesia.

The second difference of this technique is the position of the woman in labor with the introduction of an anesthetic. With an epidural, she sits, while here she will be asked to lie down in the fetal position, tucking her legs under her stomach as much as possible.

Indications

For caesarean section, spinal anesthesia in the following cases:

emergency situation, and general anesthesia is contraindicated;
performed epidural anesthesia at the beginning, which must be completed by caesarean section;
preeclampsia;
heart disease;
arterial hypertension;
diabetes;
kidney problems.

This is a gentle type of anesthesia that doctors resort to if a woman in labor has any serious problems with health. However, spinal anesthesia has a number of contraindications that must be kept in mind.

Contraindications

There are the following contraindications to spinal anesthesia during caesarean section:

refusal of the patient from this type of anesthesia;
lack of necessary equipment or a qualified specialist;
big blood loss;
disorders associated with the circulatory system;
any infections, inflammations, sepsis,;
allergy to the administered drug;
heart problems;
high intracranial pressure;
diseases of the central nervous system;
the use of heparin, warfarin or other anticoagulants immediately before surgery.

If at least one contraindication from this list has not been taken into account, the most serious complications can await the mother and child after spinal anesthesia used during caesarean section. That is why, if an operation is performed, a woman should discuss with her doctor all the problems of her health and decide if it suits her. this species drugs or not. It has its own advantages and disadvantages.

pros

Most frequently asked question, which are asked by women in labor preparing for a caesarean section - which is better: spinal or epidural anesthesia? The choice will largely depend on individual characteristics female body, the course of pregnancy and many other factors. Benefits of spinal anesthesia:

excellent pain relief without the errors that occur with epidural anesthesia;
excellent relaxation of the muscular system;
speed of action: only 5-7 minutes;
minimal effect of drugs on the fetus: with epidural anesthesia, the volume of the injected substance is much larger;
the ability to be conscious throughout all childbirth;
due to the decrease in pressure, doctors can control blood loss;
passes faster and much easier than after general anesthesia;
the use of a thinner needle than with epidural anesthesia, so that pain at the puncture site is subsequently excluded;
no risk of spinal cord injury;
lower price.

In the question of which anesthesia to choose (epidural or spinal) for caesarean section, the price does not at all determine the quality. Here it is lower only because the volume of the administered drug is much less than that used for epidural anesthesia. And, of course, not a single type of anesthesia can do without drawbacks.

Minuses

In rare cases, the consequences of spinal anesthesia as part of a caesarean section can be as dangerous as with general anesthesia. So the woman in labor should know in advance about all the shortcomings of this type of anesthesia, which include:

high professionalism of the anesthetist is required;
complications include infection, meningitis, toxic poisoning, convulsions, respiratory arrest, spinal cord injury, death, severe headaches or back pain that can last for several months after surgery;
due to an incorrect puncture, anesthesia may not work at all;
the anesthetic is weak, but still can affect the child;
limited (no more than 2 hours) time of action of the anesthetic drug:
a sharp drop in pressure in a woman in labor, which is accompanied by bouts of nausea and dizziness.

So, if you have to go through a caesarean section, it is worth weighing all the pros and cons of spinal anesthesia before using this method of anesthesia. Despite the low cost compared to epidural anesthesia, sometimes it makes sense to use the latter option.

significant date. On October 16, 1846, Thomas Morton (an American dentist) performed an operation under anesthesia. This date around the world is now considered the Day of the anesthesiologist.

Epidural anesthesia

Recently, more and more often, with a planned caesarean section, epidural anesthesia is used, which does not require such accuracy and professionalism from the anesthesiologist as with spinal anesthesia. These two types of anesthesia are very similar, but you need to understand the differences in order to make the right choice.

Differences from spinal anesthesia

Can't decide which type of anesthesia to prefer? In this case, find out in advance how epidural anesthesia is done, what is its difference from spinal anesthesia. After all, each of them will have its own consequences for your body and for the health of the baby.

Begins to act 20, not 5 minutes after the administration of the drug.
The anesthetic is injected into the epidural space of the spine, not into the cerebrospinal fluid.
The needle is much thicker.
It is inserted between the spinal canal and hard shell brain, not between the vertebrae.
The insertion of the needle is much more superficial than with spinal anesthesia.
A catheter is inserted, which remains in the spine throughout the operation. With spinal anesthesia, such a tube is absent.
More expensive, since the volume of the drug that is injected into the body is much larger.

As for the side effects that a woman can experience right on the operating table, there can be no definite answer. Different women in labor may experience different sensations under epidural anesthesia and spinal anesthesia. Some feel only a slight tingling sensation when the needle is inserted, while others experience convulsions if a nerve is inadvertently touched. So it all depends on the level of pain threshold and individual characteristics.

Indications

if it was already performed at the beginning of natural childbirth, but surgical intervention was urgently required;
serious diseases in a woman in labor: preeclampsia, high pressure, kidney or liver problems, severe myopia, ;
premature pregnancy;
contraindications for general anesthesia;
excessive generic activity, pathology of the cervix;
the wish of the mother.

If a problem arises, which is better: general anesthesia or epidural anesthesia, the doctor looks first of all at the health of the expectant mother. The last variant of anesthesia is more gentle and has a minimum negative impact to the fruit. It is for this reason that at present, preference is given to regional methods of anesthesia.

Contraindications

When preparing for a caesarean section, it is imperative to take into account all the contraindications to epidural anesthesia, of which there are a lot. Otherwise, serious complications and irreversible consequences may occur. You can not use this technique in the following cases:

having problems with blood clotting;
bleeding;
increased intracranial pressure;
tattoo on the back, affecting the puncture site;
infections, inflammations, tumors, wounds and any other lesions skin at the puncture site;
allergy to a drug;
epilepsy;
elevated temperature;
arrhythmia;
intestinal obstruction;
heart disease;
diseases of the central nervous system;
traumatic shock;
cardiovascular, posthemorrhagic collapses;
diseases of the spine and spinal cord;

For a day, women in labor are often contraindicated for the injection of Clexane used for the treatment and prevention of thrombosis. If for some reason these contraindications were not taken into account, there may be consequences of epidural anesthesia during caesarean section, which pose a danger to the health of the mother and child. If the prenatal examination was thorough, this type of anesthesia does not contain any obvious pitfalls: it has many advantages.

Advantages

Here are some benefits of epidural anesthesia for caesarean section:

complete anesthesia;
not like that strong impact on the fetus, as in general anesthesia;
a woman has the opportunity to see her baby immediately after the operation;
epidural anesthesia for cesarean section lowers blood pressure so that the surgeon can control blood loss during the entire operation;
the postoperative period is much easier to bear;
the catheter allows you to control the dosage of the anesthetic - this is the main advantage of epidural anesthesia, which spinal does not have.

Like other types of anesthesia for cesarean section, epidural has its drawbacks, which are expressed primarily in a huge number of consequences for the health of the mother and child after surgery.

disadvantages

The disadvantages of epidural anesthesia, which is used for caesarean section, include:

erroneous injection of the drug into the vessel can provoke convulsions, a sharp decrease in pressure, which lead to lethal outcome or serious damage brain;
a decrease in pressure can cause a woman to experience severe dizziness and an attack of nausea right during childbirth;
the drug introduced into the body will still have some effect (and negative) on the fetus;
if the caesarean section is not completed within 2 hours due to unforeseen complications, the epidural will have to be extended.

The most serious drawback of this type of anesthesia used during caesarean section is the consequences after epidural anesthesia, sometimes too dangerous and irreversible. It's almost impossible to predict them.

Effects

As a result of non-compliance with contraindications or individual characteristics of the mother's body, complications of epidural anesthesia sometimes occur after cesarean section. They can affect the health, even the life of both the mother and the child.

Complications for the mother during childbirth:

damage to the dura mater;
decrease in heart rate;
nausea, vomiting;
chills;
spinal cord injury;
back pain;
toxic reaction to the drug.

Postpartum consequences for a woman:

severe head and back pain;
problems with lactation;
loss of sensation in the lower extremities;
CNS disorders.

Complications for the child:

decrease in heart rate;
respiratory failure, motility;
disorientation;
difficulty sucking;

If the spouses who are about to become parents face the problem of which anesthesia is better for caesarean section, it should be solved only together with your doctor. After a thorough and circumstantial examination, he can draw conclusions and advise the most suitable option. Otherwise, the consequences of epidural anesthesia will not be long in coming. In rare cases, doctors decide to do a spinal-epidural (epidural-spinal) anesthesia.

Curious fact. One chance in 200,000 is the chance that a woman in labor will die from anesthesia.

Spinal epidural anesthesia

Combined epidural-spinal anesthesia is a method that combines both types of anesthesia. Spinal anesthesia is performed, but with catheterization. Allows you to use the advantages of both and offset their shortcomings. It was widely used during operative delivery not so long ago, but it has proven itself just fine. An increasing number of doctors are leaning towards this method of pain relief.

Knowing in advance that you will have to give birth with the help of surgery, find out in more detail what kind of anesthesia is done for a caesarean section in the maternity hospital where you are going to go to the operation. This will allow you to fully prepare for it, find out all the pitfalls, and resolve controversial, dubious issues with the doctor. The calmer mother is before a significant event, the smoother and better it will go.

Needless to say, natural childbirth is not only physiological, and therefore more “correct”, but often less risky for the fetus and even for the woman. However, unfortunately, 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 minimizing 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).

Since the operation of caesarean section involves the dissection of the abdominal cavity, then, of course, one cannot do without anesthesia. And here, women in labor and doctors are given the 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 tolerance of the drugs used by the woman during anesthesia, and sometimes taking into account the preferences of the woman herself. Not the last role is played by the availability of highly qualified specialists and the 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 the final decision.

Anesthesia for caesarean section: which is better

As with any other operation, general and local anesthesia can be used during a caesarean section. Local in this case is called regional, and there are two types: spinal and epidural anesthesia. These types of anesthesia have much in common, but, nevertheless, differ from each other.

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

The peculiarity of general anesthesia is that for the period of its influence, the consciousness of a woman is completely “turned off”. She falls into a dream, 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 a ventilator.

General anesthesia is performed by intravenous administration of 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 administered to put the woman in labor to sleep, and then - for complete muscle (including uterine) relaxation.

Indications and contraindications for general anesthesia for caesarean section

Anesthesia for 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 anesthesia for caesarean, although it is usually suitable only for healthy, strong women who endured this pregnancy without complications. Doctors resort to general anesthesia if:

it is necessary to carry out an urgent delivery (continuation of pregnancy is life-threatening for the mother or child, their condition will deteriorate rapidly);
presentation of the fetus oblique or transverse;
prolapse of the umbilical cord;
a woman has heart pathologies (with regional anesthesia, the load on the heart of a woman in labor increases);
childbirth is not possible in any other way (there are contraindications to natural delivery and to the use of regional anesthesia);
pregnant woman is morbidly obese.

The use of general anesthesia in childbirth is a responsible decision, and all risks must be weighed before making 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 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 absolutely relaxed). But the same circumstance can also 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 are serious. It is almost impossible to predict their appearance. Therefore, you just need to 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 since the introduction of anesthesia the fetus is in mother's womb. Therefore, 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 to some extent remain conscious 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 may be difficulties with work respiratory system, slowing down the nervous system, inhibition of the brain, etc.

The very same woman in labor can come out of the unconscious state in different ways: there is 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 new mother cannot immediately put her baby to her breast.

General anesthesia always carries certain risks, but the state of pregnancy increases them even more. Therefore, this type of anesthesia for caesarean section is rarely used today.

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

Much more justified is the use of regional anesthesia for caesarean. It is not only safer for mother and child, but it also has a number of other advantages, although it is not without 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 feels only pressure in the back), can be performed in a sitting position, but is more often performed on her side.

Spinal anesthesia works only in the area below the waist, while the woman remains fully conscious and understanding 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

Typically, spinal anesthesia is used in cases where gentle pain relief is required, as well as in pregnant women with certain health problems: cardiac and kidney disease, diabetes, 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 the puncture.
Violations in the structure of the spine;
Intolerance to drugs used in 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 quite quickly with the introduction of a minimum dose of anesthetic. Already 5-10 minutes after the administration of the drug, you can start the operation, and therefore, if time is patient, this type of anesthesia can be used during an emergency cesarean. Sensitivity in the lower part of the body of the woman in labor is blocked almost completely. At the same time, the muscles relax well, which greatly facilitates the work of surgeons. It is also easier to perform than a caesarean section under epidural anesthesia.

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

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

A weak concentration of drugs administered during spinal anesthesia can significantly reduce the likelihood of their negative impact on the fetus, although it does not completely exclude it. Possible development of fetal hypoxia during childbirth, slowing of the heart rate and depression respiratory functions baby.

There are other disadvantages of such genera:

The implementation of spinal anesthesia requires the participation of highly qualified experienced anesthesiologists and auxiliary medical staff, specific equipment and materials, and strict observance of sterility during the operation.
1 in 10 women in postpartum period there are headaches of varying intensity, which, however, are easily removed with the help of appropriate drugs. Due to the decrease in blood pressure, weakness and nausea are also felt.
Sometimes there are temporary violations of urination.
Allergic reactions to drugs used in anesthesia are possible.
Very rarely possible neurological disorders at the mother. However, doctors assure that they disappear within one or two months after childbirth.

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

Epidural anesthesia for caesarean section

Epidural anesthesia is very similar to spinal anesthesia in terms of the mechanism of conduction and action. However, there are still some differences. It is also carried out using a puncture in lumbar, but at the same time it provides for the installation of an epidural catheter: if during the operation it is necessary to prolong or increase pain relief (as well as in the postoperative period), then this can be easily done by adding an anesthetic through the catheter, which is impossible with spinal anesthesia.

In addition, thanks to the same catheter, drugs can be introduced 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

A 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, other cardiovascular diseases. You can not 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 proposed injection, blood coagulation in 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 plus of regional anesthesia. However, it would not be superfluous to mention here that there are reviews on the Internet that an injection with regional anesthesia is far from painless. This depends not only on the sensitivity threshold of the patient, but to a large extent also on the type of needle used for puncture and the experience of the anesthetist. That is why you need to be ready for different sensations. However, the main thing is that then anesthesia still occurs, which is the purpose of the injection.

The action of epidural anesthesia occurs gradually, incrementally, which reduces the load on cardiovascular system mother. Due to the fact that the duration of the epidural can be increased during the operation, this type of anesthesia is especially important for childbirth, which, for various reasons, takes a long time. But there are also negative points.

The possible consequences for the fetus during an epidural are similar to those for spinal anesthesia. In both cases, to return sensation to the legs of a woman, it is required certain time after the end of the operation. The consequences of epidural anesthesia for the mother are almost the same as with spinal anesthesia.

Epidural anesthesia, like spinal anesthesia, is relatively complex in technique and requires special training on the part of physicians. If spinal anesthesia begins to act after 5-15 minutes, then epidural - after 20-40 minutes, and therefore it cannot be used in emergency cases (only planned). But headaches after such an operation occur less frequently, 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 caesarean section will be best, we can definitely say that the advantage is given to spinal anesthesia as safer for the fetus. And with the advent of anesthesiologists in the arsenal, more and more modern medicines and equipment, spinal anesthesia is less likely to cause undesirable consequences for the mother. However, everything is determined by the situation and medical indications.