Anesthesia for cesarean section and birth - preparation , complications of anesthesia

Contents:

  • Do not worry and completely trust the doctor
  • patient role
  • What information do you need to provide the anesthesiologist?
  • Allergy
  • Do I need to fast before surgery?
  • General or regional anesthesia?
  • advantages of regional anesthesia techniques
  • risks and complications associated with anesthesia

This article is intended for women who are preparing to leave, and who are interested in the question of analgesia and anesthesia during labor and caesarean section.The woman is very important to be timely informed about the upcoming procedure, anesthesia delivery or choice of anesthesia for caesarean section.

In preparation for the operation you sure there are many questions about the preparation for it, ensuring maximum safety during anesthesia and monitoring in the postoperative period.In this article I will try to fully describe the preparations for the operation and possible methods of anesthesia, appropriate for the operation.

Do not worry and completely trust the doctor

All anaesthesiologists working in hospitals, seven years have passed training in public health institutions of higher education, followed by specialization in anesthesiology and intensive care.Also produces training in Israel, the developed countries of Europe with the issue of the relevant certificates.Constantly held training courses in leading national and international medical centers.

patient role

There are several simple guidelines that can make anesthesia for your operation safer.

  1. Keep your body in shape.Regular walks in the fresh air.Try as much as possible to control your weight.Implementation of anesthesia in patients with excess weight is associated with an increased risk of developing complications.
  2. If you smoke, quit.Do this for at least six weeks before the upcoming surgery.Otherwise, the increased risk of respiratory disorders during anesthesia and postanesthetic period including cessation of breathing.
  3. Throughout the period of preparation for surgery not drink alcoholic beverages.According to statistics, confirmed by my own experience, abuse of alcohol significantly increases the risk of circulatory disorders (up to stroke).In our clinic, each year 2-4 cases of cerebral circulation in pregnant women after drinking.In addition, alcohol significantly influences on the course of anesthesia and may require administration of high doses of drugs that have a negative impact on your health and the health of the child.
  4. Continue taking previously prescribed medication, but do not forget to notify passable treating your anesthesiologist and surgeon.
  5. When taking aspirin, nonsteroidal anti-inflammatory drugs and other medications that affect blood clotting, consult your anesthesiologist about the time of discontinuation of these drugs before surgery.
  6. If you are experiencing any health problems, notify the anesthesiologist and the surgeon.Provide them with the full, comprehensive information.You may need additional tests involving specialists.This is best done 1-2 weeks before the forthcoming operation.
  7. If you wish to obtain further information about the forthcoming anesthesia, check with your anesthesiologist before admission.
  8. Do not eat and do not take products that contain herbal extracts, for three weeks before surgery.
  9. Put anesthesiologist aware if you are taking sedatives.Some of these can affect the course of anesthesia.
  10. If, by virtue of the moral or spiritual principles you do not accept transfusions of donated blood, please inform the surgeon and the anesthesiologist.

What information do you need to provide the anesthesiologist?

Your anesthesiologist is required to appoint a preoperative examination to the joint decision on the method of anesthesia, as well as to carry out the necessary examinations.For the anesthetist will need to know:

  • your health at the time of inspection, as well as transferred in the near future disease.Particular attention will be paid to diseases of the heart and respiratory system.
  • Postponed you before surgery and the problems that arose during previous anesthesia.
  • Noted Are you an abnormal response and side effects after administration of any drugs, as well as the occurrence of allergic reactions to medications.
  • have or have ever observed the following symptoms: reflux, heartburn, asthma, bronchitis, heart problems or any other pathological condition.
  • Are you taking at the moment any drugs, including alcohol and tobacco.Please bring with you all currently used drugs in their original packaging.
  • Do you have in your mouth wobbly teeth, dentures, implants.

anesthesiology is important to make a comprehensive view of your medical condition to determine the most suitable method of anesthesia.Answer questions honestly.This will significantly reduce the risk of anesthesia.

Allergy

If you have observed or have ever observed increased sensitivity to any medicines, as well as patients with systemic allergic reactions, asthma, polyvalent (multiple) drug allergies before surgery is necessary to pass the so-called leykopenicheskytest.This test determines the increased sensitivity to several drugs used in our clinic for anesthesia.For us used drugs include:

  • Bupivacaine (marcaine);
  • Naropin (ropivacaine);
  • Kalipsol (ketamine);

also in the postoperative period, you will be introduced by an antibiotic (ampicillin, cefazolin) and means for uterine contractions - hormonal drug oxytocin.

All of these drugs should be included in the checklist leykopenicheskogo test.

When you present your admission test result to your doctor, surgeon and anesthetist.

Do I need to fast before surgery?

We understand all the inconveniences associated with the restriction of food intake, and water, but the complete elimination of food and fluids from the diet is the golden rule of preparation for general anesthesia.During anesthesia, food or liquid located in the stomach, can trigger vomiting and into the lungs.

Specific instructions regarding the issue of fasting you will get after a conversation with your anesthetist.As a rule, patients are prohibited meal the night before surgery.The only exception is a simple drinking water or mineral water without gas.A glass of this water is recommended to drink the morning of surgery.It contributes to the normalization of gastric acidity.

General or regional anesthesia?

This question is particularly relevant in recent years, as the types of anesthesia for caesarean section are experiencing rapid development, and constantly improved.There are several different methods of anesthesia, which differ depending on the drug used for anesthesia.Also, there are situations in which using multiple methods of anesthesia.In fact, it will depend on the nature and duration of the operation:

  • the duration of cesarean section affect multiple pregnancy
  • presence of adhesions in the abdominal cavity after previous operations
  • excessive extra patient weight and other factors

General anesthesia

during the operation you will be in a state of unconsciousness, which is achieved by intravenous administration of drugs, sometimes in combination with inhaled anesthetics (gases for anesthesia).

During anesthesia, when you can not control their condition, all the vital functions of your body are controlled by an anesthesiologist, who is careful monitoring of all necessary parameters and continually adjusts the level of anesthesia with an additional injection of sleeping pills and painkillers.

accepted that general anesthesia for surgery has a definite impact on the child, as by intravenous administration of drugs through the bloodstream, they cross the placenta.In this regard, the anesthetist will calculate the optimum dose of administered drugs, without reaching their critical concentration in the mother's body.

Indications for general anesthesia:

  • allergy to drugs used in regional anesthesia
  • categorical refusal patient from epidural anesthesia
  • loss loop cord or transverse position of the fetus
  • obese women
  • injury or spinal surgery (anatomicchanges)
  • situation requiring emergency surgery - pre-eclampsia, bleeding
  • true placenta accreta
BENEFITS:
DISADVANTAGES:
  • instant pain relief (especially important when an emergency cesarean section)
  • better tolerated by women, because consciousness is disconnected
  • optimal conditions for surgeons, becausethere is a complete muscle relaxation
  • extending the anesthesia introduction of additional doses of anesthetic
  • all anesthesiologists own methodology ETN
  • narcotic drugs act on the fetus, the child is exposed to a narcotic sleep
  • may develop CNS kid depression (lethargy or ischemia-gipoksicheskaya encephalopathy) in the future, therefore, premature labor and fetal hypoxia general anesthesia is not desirable
  • ETN causes cough and sore throat, which takes place in 2 days.
  • there is a risk of aspiration syndrome (Inhalation of stomach contents the way), which can cause pneumonia or respiratory failure
  • may cause tachycardia and high blood pressure
Regional anesthesia

nerve impulse transmission blocking, causingtemporary numbness in the area of ​​the proposed surgery.With this method of anesthesia during surgery can be fully conscious, at the same time without feeling pain, or in a state of medical sedation (light anesthesia, allowing the patient to achieve a dream).The most common example of regional anesthesia are:

  • Epidural anesthesia for labor analgesia;
  • Spinal anesthesia for cesarean section.

There are several types of anesthesia, but only by using the methods described above can be achieved for a caesarean section analgesia required.

epidural and spinal anesthesia are varieties of regional anesthesia.They are used for anesthesia maintenance operations as well as for pain relief in some diagnostic procedures, expressed pain syndrome, childbirth.

Epidurals

In our clinic, this method is provided mainly anesthesia during birth vaginally.

  • Epidural anesthesia is the introduction of the anesthetic into the epidural space (in the vicinity of the spinal canal) through thin plastic or silicone catheter, which is established through a special needle (it is removed after the catheter).
  • Through this catheter will be administered a local anesthetic and other drugs that reduce pain sensitivity.The mechanism of action of this method is based on blocking the transmission of pain impulses from the brain receptors.
  • catheter firmly fixed on your back and allows you to continue anesthesia for a long time.
  • you may be offered a permanent slow introduction of a solution or a special dispenser equipped with a button for the self-administration of the required dose of the anesthetic.This is called patient-controlled epidural analgesia (EDA).
  • time from administration of anesthetic to the development of analgesic effect in this method is about 20 minutes.
BENEFITS: DISADVANTAGES:
  • woman is conscious and can hear the cry of a child and see him immediately after birth
  • as the indwelling catheter, ie the possibility of extending anesthesia if necessary
  • risk exposuredrugs on the fetus minimum
  • relatively stable state CCC
  • analgesia effective
  • saved relative physical activity
  • no risk of tracheal trauma or aspiration syndrome
  • from anesthesia before the operation takes 20 minutes
  • technically complicated procedure
  • there is a risk of inadequate analgesia
  • risk of intravascular injection, which is dangerous development sudorogo and even fatal
  • administration of anesthetic under the arachnoid, the occurrence of spinal block requires urgent resuscitation of the patient

spinal anesthesia

  • spinal anesthesia for cesareansection (CMA) assumes a single injection of anesthetic into the spinal canal through a very fine needle.This method, like the epidural, is based on blocking the transmission of pain impulses to your brain.
  • This type of anesthesia requires a short period of time to achieve the desired effect (5-10 minutes).After the effect of anesthesia lasts for 1-4 hours (depending on the administered drug).
  • during spinal anesthesia you'll be awake, you hear the first cry of the child and spend the first feeding of the child directly in the operating room.
  • before performing spinal anesthesia you will definitely establish venous catheter and provide intravenous saline drip.
  • In the state of anesthesia during surgery can be observed "strange" feeling of touching or pressing in the field of surgery.At the same pain receptors will be blocked, which will ensure the absence of pain.
BENEFITS: DISADVANTAGES:
  • 100 anesthesia, unlike EDA
  • rapid effect already at 5-7 minute
  • technically easier CMA EDA
  • less epidural anesthesia
  • no risksystemic exposure to anesthetic
  • woman can also see the baby and is conscious
  • muscle relaxation is good (optimal conditions for surgeons)
  • no drug effect on the child
  • less painful procedure, since thinner needle than for EDA
  • as anesthetic fast acting falls sharply blood pressure (which proactively warn)
  • frequent cases of PDPH, so she will need to at least the day is in the horizontal position
  • inability to extend analgesia (length not more than 2 hours)
  • possible painback in the next few months

advantages of regional anesthesia techniques

Over the past 3 years in our center, about 90% of caesarean sections were performed using regional anesthesia techniques.

transition to regional methods explained significantly lower risk of developing postanesthetic and postoperative complications.

The following are the main advantages of regional anesthesia techniques before general anesthesia.