Anesthesia during caesarean section. Benefits of epidural anesthesia. Dense attachment and placenta accreta

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A caesarean section is performed when the child is in labor. naturally are contraindicated and threaten both the health of the mother and the child. If a caesarean section is planned, there is time to prepare the woman in labor for it. In such cases, sometimes a woman is given the right to choose anesthesia for a caesarean section, but often it is determined by the anesthesiologist individually, taking into account the reasons that led to the operation, the type of operation (planned, unplanned), as well as the condition of the woman and her child.

Today, there are several methods of anesthesia for this operation: general, epidural and spinal. Each type of anesthesia for caesarean section has its own pros and cons. This article will help you figure out which anesthesia is best, as well as in what cases it is rational to use one or another type of anesthesia.

The nuances of general anesthesia

Today, during delivery, general anesthesia is used only in in case of emergency, due to the fact that this type Anesthesia has a greater risk than other types of anesthesia, but it requires a minimal amount of time. First, the pregnant woman is given an anesthetic intravenously. Literally after a few seconds, when the drug takes effect, a tube is placed in the trachea to supply oxygen and anesthetic gas. And the third part of the general anesthesia is my relaxant. This drug relaxes all the woman’s muscles. And only after this the operation itself begins.

Fortunately, there are not many indications for general anesthesia for caesarean section. But it is not replaceable in the following cases:

When anesthesia is contraindicated for other types of caesarean sections. For example, bleeding, morbid obesity, major surgery on the spine, blood clotting diseases and others;
Threatening condition of the fetus. This may include prolapse of the umbilical cord, abnormal position of the fetus;
If a woman in labor refuses regional anesthesia during a caesarean section;
During an emergency operation, when every minute may be the last.

This type of anesthesia for caesarean section has very few contraindications, but there are plenty of disadvantages that affect both mother and child:

The main risk is aspiration. What does it mean? Stomach juice can enter the lungs, which can cause respiratory failure and pneumonia;
Since narcotic drugs penetrate the placenta, depression of the central nervous system newborn It is of particular importance in the case premature birth, as well as in the case when the time between the introduction of anesthesia and delivery increases. But there is no need to worry too much, because modern drugs for anesthesia, the effect on the fetus is minimal and short-lived. And thanks correct actions the anesthesiologist will not have serious consequences;
Female hypoxia. This is due to the high oxygen demand of the pregnant woman;
There is a risk that tracheal intubation (insertion of a disposable tube into the trachea) becomes impossible for a number of reasons. And connection to the device artificial respiration does not seem possible;
Possible increased blood pressure and increased heart rate;
The most common and easiest side effects: muscle pain, nausea, dizziness, cough in the throat, injuries to the lips, teeth and tongue.

Despite the large number of disadvantages, general anesthesia for caesarean section has a number of advantages.:

rapid immersion in an anesthesia state, which is very an important condition in threatening cases;
excellent conditions for the surgeon, due to complete muscle relaxation;
is quite easily tolerated by a pregnant woman, since correct use pain is completely absent;
cordially - vascular system works stably and in comparison with regional anesthesia there is practically no decrease in pressure;
anesthesiologists more often choose this method of anesthesia. Here, an operating technique is used that is more often practiced and easier to use.

Epidural pain relief

Often, epidural anesthesia is used in cesarean sections when it is planned, since in this case time is required for preparation. It is not always possible to make a puncture in emergency cases, since the injection is made in a certain place above the spine at the lumbar level. And to the place where the nerves come out spinal cord in the spinal canal, an anesthetic is injected through a thin soft tube (catheter). At any time, medication is added through the catheter as needed. The result of anesthesia is clear consciousness. But all sensitivity below the belt disappears: pain, tactile and temperature. The patient ceases to feel her lower body and cannot move her legs.

Like other types, epidural anesthesia for caesarean section has its own indications and contraindications, advantages and disadvantages.

Indications:

Premature birth (less than 37 weeks of pregnancy). This type of pain relief causes muscle relaxation. pelvic floor, the fetal head experiences less overload and moves easier through the birth canal;
Increased arterial pressure or gestosis - epidural anesthesia during cesarean section causes a decrease in pressure;
Discoordination labor activity. With this complication, the parts of the uterus contract with varying degrees of activity, and there is no coordination of contractions between them. This may be due to the high contractile activity of the uterine muscles. A woman's psychological stress can also lead to this result. Epidural anesthesia for caesarean section slightly weakens the intensity of contractions and inhibits the effect of oxytocin;
Prolonged labor. Lack of complete relaxation for a long period of time leads to abnormalities in labor; in this case, it is necessary to use anesthesia so that the pregnant woman can rest and recuperate.

Contraindications:

Blood clotting disorder;
Close location of pustules to the puncture site;
Infectious diseases;
Allergy to medications used;
Severe spinal deformities;
Scar on the uterus (not always);
Incorrect position of the fetus (oblique or transverse);
The child's weight is high narrow pelvis;
The patient's refusal of epidural anesthesia for caesarean section.

The benefits are as follows:

Clear consciousness of a pregnant woman. The risk of intubation or aspiration is eliminated. The woman is conscious and can enjoy the whole process of bringing a child into the world;
No irritation to the upper respiratory tract. For women suffering bronchial asthma this anesthesia is preferable;
The patient's cardiovascular system remains relatively stable, as the painkiller gradually gains strength;
The relative ability to move is preserved. This is a particularly important condition if the pregnant woman has any muscle pathologies;
Carrying out long surgery. Epidural anesthesia allows you to increase the time of anesthesia, thanks to a catheter through which the anesthetic can be re-supplied;
Pain relief in the postoperative period. For postoperative pain relief, it is possible to administer special substances called opioids.

Disadvantages of anesthesia:

Risk of erroneous intravascular administration. And if the error is not detected in a timely manner, seizures and a sharp drop in blood pressure may develop;
Danger of subarachnoid injection. This means injecting an anesthetic under the arachnoid membrane of the spinal cord. It is possible to develop a total spinal block if such an injection is not detected;
The epidural anesthesia procedure is more complex than other types of pain relief;
The operation can begin after a certain period of time, since it takes 10-20 minutes before the anesthesia begins to take effect;
There is a possibility of inadequate pain relief. Sometimes the cruciate nerves are not blocked and discomfort occurs during surgery;
Some drugs used for epidural anesthesia cross the placenta. This may lead to a decrease heart rate child, breathing disorder of the newborn;
There may be discomfort after surgery: back pain, headache, tremors in the legs, difficulty urinating.

But you shouldn’t worry too much, because the experience and vigilance of an anesthesiologist and pediatric neonatologist will help avoid serious complications.

Spinal anesthesia during surgery

Spinal anesthesia for caesarean section is similar to the previous type of anesthesia, but unlike epidural anesthesia, the needle is inserted somewhat deeper, since it requires puncture of the dense membrane surrounding the spinal cord in the lumbar region of the back between the vertebrae.

This type of anesthesia is also called spinal. The puncture is performed between the 2nd and 3rd, or 3rd and 4th lumbar vertebrae, because the spinal cord ends here and there is no danger of damaging it. Although this anesthesia is performed in the same place as the epidural, a thinner needle is used. The dose of the drug is smaller and it is injected below the level of the spinal cord into the space containing the cerebrospinal fluid.

This type of anesthesia also has its contraindications.:

Skin infection at the site where the puncture is to be made;
If the patient’s blood clotting function is impaired, as well as circulatory disorders;
Sepsis;
Certain forms of neurological diseases;
In case of existing diseases of the spine in which it is impossible to perform a puncture;
Refusal of the woman in labor.

This type of regional anesthesia has significant advantages:

At correct introduction anesthesia, complete pain relief is achieved;
The possibility of carrying out an urgent operation, preparation for the operation can begin a couple of minutes after the time of administration of the anesthetic drug;
The procedure for performing spinal anesthesia is quite simple compared to epidural, due to the fact that the puncture site can be accurately determined;
In case of incorrect intravascular administration of anesthetic toxic reactions do not arise;
Cheaper than other types of anesthesia used for caesarean section.

But there are also disadvantages:

The duration of action is limited (about 2 hours), although this period of time is sufficient for the operation;
Due to the rapid onset of action of the drug, there is a risk of lowering blood pressure. At the right measures prevention of this can be avoided;
Possible post-puncture headache in the frontotemporal region for 1 to 3 days. But again, this depends on the experience of the physician.

Which anesthesia is preferable?

There is no type of pain relief that does not have contraindications and disadvantages. Absolutely every anesthesia listed above has both pros and cons. But after analyzing the above about anesthesia during a cesarean section, we can conclude that the most optimal option is spinal anesthesia.

It would not be superfluous to add that the material in this article is only for general development. Under no circumstances should you use the acquired knowledge during childbirth, or argue with anesthesiologists after surgery. After all, when choosing a method of pain relief, adjustments are made for the current situation.

Video broadcast about caesarean section

Approximately 20% of babies are born in a non-standard way - through a surgical incision in the anterior wall of the abdomen and uterus. This operation is called a caesarean section and has been practiced for decades. For what indications and for what period is a caesarean section performed, how is the procedure carried out, under what anesthesia - these and many other questions prevent expectant mothers from sleeping peacefully. All the most interesting and important information we will try to present it here.

Any surgical intervention, even the most minor one, to a certain extent carries a potential danger to the health (and sometimes to the life) of the patient. That’s why a pregnant woman cannot “order” a caesarean section from her attending physician just like that, for no apparent reason. And although in society one can find an opinion about the attractiveness of artificial childbirth due to its efficiency and painlessness, from a medical point of view, natural childbirth will always be a priority.

There are absolute and relative reasons for surgery.

Absolute readings:

The first child was born by cesarean section and independent childbirth can lead to complications.
The baby is positioned across the uterus or “sat” on the butt.
U expectant mother have been diagnosed with any disease or condition that could cause the baby to die during childbirth.
The baby's head is too large to fit through the pelvic bones.
Severe late toxicosis.
Multiple pregnancy.

Relative readings:

Anatomically non-standard development of the mother's skeleton (for example, a narrow pelvis not intended for natural childbirth).
Big baby with breech presentation.
Pregnancy beyond the expected due date.
Varicose veins of the genital tract in a pregnant woman.
Pathologies of uterine development.
Questionable condition of scars from previous operations on the uterus.
Spicy and chronic diseases mothers who can help Negative influence on the course of labor or harm the mother in labor (high degree of myopia, arterial hypertension).
Late birth.
Previous history of artificial insemination, spontaneous abortion or stillbirth.
Severe swelling.

A planned caesarean section is usually prescribed in the following cases:

Heavy infectious diseases from the expectant mother.
The pregnant woman is HIV-infected.
During prenatal diagnostics, symphysitis was discovered (excessive enlargement of cartilage in the area of the pubic symphysis).
Shortly before birth, intrauterine fetal hypoxia was established.

Caesarean section: contraindications to surgery

Artificial birth is not performed if:

the child died in the womb;
the baby was diagnosed with congenital malformations incompatible with life;
infection occurred skin and the mother's genitals.

In all of the above situations, during a cesarean section, the risk of developing sepsis and peritonitis due to infection in the blood increases sharply.

How many weeks is a caesarean section performed?

A planned caesarean section is prescribed during pregnancy, and only the doctor can determine the final date of the operation. Optimal time to start the procedure – the first contractions. In order not to miss an important moment, the expectant mother goes to the maternity hospital 1 - 2 weeks before the birth date.

A planned caesarean section is prescribed no earlier than 37 weeks of pregnancy. In what week a cesarean section is performed depends on the decision of the specialists. Choosing a day for surgical intervention, the doctor always focuses on the expected date of birth of the baby. To prevent the development of intrauterine hypoxia, cesarean section is performed at 38–39 weeks.

If the first pregnancy ended in surgical delivery, the second child will also be born via cesarean section. Repeated operation, as with the first birth, is prescribed for a period of 38 to 39 weeks, however, if the doctor is confused by the condition of the suture from the first cesarean section, the woman in labor will be operated on before the PDR date.

How to do a caesarean section: the preparatory stage

The doctor will definitely inform the woman in labor about necessary measures preparation for surgery. 12 hours before the procedure you need to refrain from eating and 5 hours from drinking. An enema is given immediately before a cesarean section. There is little pleasure, but the risk of contracting an infection during childbirth is practically absent, and the rehabilitation process will go faster.

During the operation, the integrity of the abdominal muscles is disrupted by a large incision. At first after artificial childbirth, even the slightest tension in the abdomen will cause noticeable discomfort, despite drug pain relief. And an enema done before the operation will relieve the young mother from the agony of trying to go to the toilet “in a big way” in the first days after a cesarean section, since the intestines will be relatively empty.

If this matters, the expectant mother will be warned about the need to epilate her pubis.

How to do a caesarean section: procedure sequence

The operation is carried out in several stages and is certainly accompanied by anesthesia. The woman in labor will be offered three options for pain relief: epidural, spinal anesthesia or general anesthesia. We'll talk more about them a little later.

Once the painkillers have taken effect, the doctor will make an incision in the pregnant woman's abdomen. Most often, this manipulation is carried out using the Pfannestiel method - the incision runs along the growth line pubic hair. In emergency cases, when every second counts, a lower-median incision is performed - from the navel along the midline down to the pubis. During elective surgery The uterus is cut, like the abdomen, horizontally. A vertical incision is performed in case of multiple pregnancy or pathological attachment of the placenta.

Through an incision, the doctor removes the baby from the uterus, separating the placenta. Afterwards, the newborn is placed on the happy mother’s chest or handed over to the father’s hands. Then the baby is sent to the ward of the children's department.

After the baby is removed, oxytocin and methylergometrine are injected into the uterus, which help the hollow muscular organ to contract faster. The operation is completed by suturing the cut tissues with a self-absorbing suture material. First, the uterus is sutured, then the peritoneum, muscles, ligaments and skin. The skin is fastened with a regular or intradermal (more accurate and aesthetic) suture.

How long does a caesarean section take? The operation takes approximately 30 – 40 minutes. After its completion, the new mother is sent to the intensive care unit to recover from anesthesia, and then to the postpartum ward. To avoid the development of vein thrombosis, the woman is raised from bed immediately a few hours after the anesthesia has stopped working. Walking – best prevention blockage of blood vessels. It is strictly forbidden to lift anything heavy.

Who performs a caesarean section in the maternity hospital depends on the policy medical institution and on the health status of the mother and her baby. Usually these are 2 obstetricians-gynecologists, 1 anesthesiologist, 1 midwife who receives the child and 1 neonatologist.

Anesthesia for caesarean section

Artificial birth - serious abdominal surgery and it is carried out only with preliminary anesthesia. There are several types of anesthesia that are used to make a woman feel comfortable during surgery.

Epidural anesthesia for caesarean section

To deprive the mother of sensitivity using this method, an injection is made under the spine in the lumbar region - where the spinal nerves are located. A catheter is left at the puncture site, through which an anesthetic is periodically injected during the operation.

The main advantage of epidural anesthesia is that the woman in labor does not fall asleep and is perfectly aware of everything that is happening to her, but does not feel the lower part of her body. The woman is immobilized from the waist down and will not suffer much pain as doctors make cuts to remove the baby.

Among other “advantages” of this type of anesthesia, we note:

ideal for women who suffer from bronchial asthma;
does not distort the work of cardio-vascular system, since the painkiller is supplied to the body in doses;
Thanks to this injection, the administration of opioid anesthetics after surgery is allowed.

Despite the obvious advantages of the procedure, epidural anesthesia for caesarean section has certain disadvantages and consequences.

This type of anesthesia is not suitable for:

blood clotting disorders;
infections;
allergies to painkillers;
transverse presentation of the child;
uterine scar;
the presence of inflamed or purulent areas in the puncture area;
curvature of the spine.

We also list the disadvantages of the method. There are women for whom they are of decisive importance:

the likelihood of the anesthetic drug getting into the choroid or arachnoid membrane of the spinal cord, as a result of which the woman in labor develops convulsions and the pressure drops sharply;
high degree of complexity of the procedure;
anesthesia gains strength only 15 - 20 minutes after the injection;
sometimes anesthesia is only partially effective, so the woman in labor is forced to experience obvious discomfort during the operation;
the likelihood of pain medication entering the placenta, which causes disturbances in the baby’s heart rhythm and breathing.

If anesthesia in the form of epidural anesthesia is performed during a caesarean section, the pregnant woman must be warned about the consequences of such a step: back pain and headaches, tremors lower limbs, problems with urination.

Spinal anesthesia for caesarean section

This type of anesthesia is in many ways similar to the previous technique. The injection is carried out in the back, but in this case a very thin needle is inserted even deeper, directly into the spinal lining. The injection is made strictly in a specific place (between 2 and 3 or 3 or 4 vertebrae) so as not to damage the spinal cord. For spinal anesthesia during cesarean section, a smaller volume of anesthetic is required than in the previous version.

Advantages of spinal anesthesia:

complete loss of sensitivity;
rapid onset of effect – a few minutes after the anesthetic enters the body;
low likelihood of complications due to the precise location of drug administration;
absence of unexpected reactions in case of incorrect injection.

Disadvantages of spinal anesthesia:

short duration - the injection lasts no more than 2 hours;
the possibility of a decrease in blood pressure if the anesthetic is administered too quickly;
the risk of developing headaches, which persist on average up to 3 days after surgery.

Doctors are forced to refuse to perform surgery under spinal anesthesia if a pregnant woman has contraindications to such anesthesia:

rash or pustular formations at the site of the intended injection;
circulatory and blood clotting disorders;
blood poisoning;
neurological diseases;
pathologies of spinal development.

General anesthesia for caesarean section

Today, general anesthesia for artificial childbirth is used less and less often, since of all types of anesthesia it has the most negative effect on the mother and child. The procedure involves intravenous administration of an anesthetic, during which the pregnant woman falls asleep within a few seconds. A tube is then inserted into the woman's trachea to artificially supply oxygen.

General anesthesia for caesarean section is performed in the following cases:

obesity, previous spinal surgery, blood clotting pathologies - other types of anesthesia for these diseases are not suitable;
fetal presentation, prolapse of the umbilical cord;
the need for an emergency caesarean section.

Advantages of general anesthesia:

almost instant loss of sensitivity.
no interruptions in the functioning of the cardiovascular system;
no difficulties in administering anesthesia.

Disadvantages of general anesthesia:

probability of penetration gastric juice into the lungs with subsequent development of pneumonia;
the likelihood of a harmful effect of the anesthetic on the central nervous system of the newborn;
the risk of developing hypoxia in a woman in labor.

The best anesthesia for caesarean section is the one chosen by an experienced specialist. Only a doctor can take into account the advantages and disadvantages of each type of anesthesia and correlate them with the well-being and condition of a particular woman in labor. In this matter you should trust exclusively professionals.

Possible complications after cesarean section

During the birth of a child, a woman experiences an enormous burden and is subjected to extreme stress, regardless of whether the birth is natural or artificial. The surgical intervention is not very long, but may result in some complications for the woman in labor, including:

bleeding;
inflammation of the uterus;
thromboembolism;
adhesions;
hernia in the scar area;
damage to certain organs during cesarean section (for example, the bladder).

Not only the woman, but also the newborn child may face unpleasant complications due to the operation:

the risk of being born prematurely if a planned caesarean section is scheduled for an earlier date than the PDR. In this regard, it will be difficult for the baby to adapt to the outside world. In addition, practice shows that “Caesarean babies” get sick more often than children born independently;
anesthesia, even the weakest, also affects the baby. In the first hours of life, the newborn is sleepy and inactive. There is a risk of developing pneumonia due to anesthesia;
After a caesarean section, mother and child are not together for some time. This may subsequently affect breastfeeding not in the best way.

Rehabilitation period after cesarean section

It will take several months after the operation before the woman fully recovers and feels well. During this period, it is important to treat your health with great attention.

On the first day after cesarean section, you are only allowed to drink. Choice limited to still water room temperature. The next day you can eat yogurt, porridge, sweet tea and lean meat. A light diet should be followed for about a week after surgery.
After surgery, the stitch hurts a lot for some time, so the woman is prescribed painkillers. As you recover, the discomfort weakens every day.
For 2 - 3 weeks after Caesarean woman will have to strictly observe intimate hygiene, since at this time she will still be disturbed bloody issues. Then they will completely disappear.
About 2 weeks after the birth of the baby, you need to regularly treat the suture on the abdomen to prevent it from becoming infected and rotting. In this case, the state of health is overshadowed by severe cutting pain in the incision area. The tissue at the site of stitching first turns red, and later, when the scarring process begins, turns purple. In the future, the color of the scar will almost merge in color with the skin. The incision on the uterus will heal within six months.
2 months after the operation, the woman is recommended to gradually get involved in sports. Intensive training is allowed only after 6 months. Sex life It is best to resume 1 month after birth.

IN Lately More and more expectant mothers are thinking about the possibility of giving birth to a baby through a caesarean section. Perhaps women are afraid of the pain during natural childbirth. However, the risk of complications is present both during independent and operative childbirth. Before you finally decide on how the little man will come into this world, you need to carefully listen to the arguments of your attending physician about the “pros” and “cons” of a cesarean section.

How to do a caesarean section. Video

Spinal anesthesia for caesarean section is common in modern maternity hospitals. This method of pain relief during surgery has several advantages. The selection of anesthesia is carried out by a doctor. The specialist examines the progress of pregnancy and the woman’s medical history. Only based on the data obtained, the anesthesiologist determines the type of anesthesia.

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

During a caesarean section, three types of anesthesia are used: deep anesthesia, spinal or subarachnoid anesthesia, and epidural anesthesia. The choice depends on the reasons for the caesarean section.

Many clinics use anesthesia. This method allows you to adjust the surgical process. The specialist can also choose a drug suitable for long-term sleep. But European maternity hospitals rarely use anesthesia. Preference is given to spinal or epidural anesthesia. The difference between these methods lies in the features of administering the drug into the spinal canal.

For epidural anesthesia, a catheter is used. It is installed in the intervertebral space. Through it it is introduced active substance. Spinal anesthesia is performed using a thin, long needle. It is inserted into the spinal space. An anesthetic drug is injected through a needle.

All of the above techniques have positive and negative sides. To choose the right method of pain relief, you need to consult a doctor. He will explain what problems may arise after surgery. The specialist will also select a method suitable for each patient individually.

Positive aspects of the procedure

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

The positive effect is complete preservation of consciousness. Spinal anesthesia applies only to the lower torso. The brain and thoracic region work as usual. This method of performing a cesarean section gives the woman a chance to control the process and attach the baby to the breast in the first minutes after birth. After anesthesia, the patient needs some time to restore brain function. Spinal anesthesia eliminates the post-anesthesia state.

Many women are afraid of having a caesarean section because psychological state. Fear of the unknown during surgery is accompanied by the development of stress. For this reason, pain relief using this method avoids additional inconvenience. The child is immediately shown to his mother. The woman can watch as doctors weigh and measure the baby.

The average duration of action of the drug is 120 minutes. This time is enough to carry out all the necessary manipulations. In this case, the patient does not experience any pain. The drug relieves sensitivity in the abdominal area, lower extremities and pelvis. After surgery is completed, the new mother can perform her usual activities without additional inconvenience. After normal anesthesia, recovery is required within two days. Consciousness returns fully after this period. Spinal anesthesia eliminates this stage postoperative recovery. On the day of surgery, the patient can perform a number of permitted actions.

The positive side is the speed at which the drug begins to act. The first signs of the drug's effect appear within five minutes. In ten minutes the woman can be operated on. This effect is used for emergency caesarean section. If natural childbirth is not accompanied by dilatation of the uterus, doctors administer an anesthetic and perform a Caesarean section on the woman.

What else do you need to know

Any prescription of a drug must be carried out by a doctor. Many drugs have a negative effect on the child. Medicines used for spinal anesthesia do not affect the condition of the fetus. This effect is due to the peculiarity of its administration. The active substance blocks the functioning of the nerve endings of the spinal column. Due to this, an analgesic effect is achieved. Absorption of the drug into the bloodstream occurs slowly. Since the fetus receives all harmful and beneficial substances through the placenta, anesthesia does not cause harm.

When anesthesia is used, part of the substance is absorbed into the bloodstream. The first day after a cesarean section, the baby may be lethargic and have difficulty latching on to the breast.

Unlike many drugs used for anesthesia, the anesthetic has a minimal amount side effects. Development adverse reactions possible, but rarely diagnosed.

Negative points

Spinal anesthesia has a number of negative aspects. Unpleasant moments should not be excluded. The following negative consequences of the intervention may occur:

pain in the puncture area;
partial numbness of the lower extremities;
migraine headaches;
a sharp decrease in body temperature;
hypotension.

During the first week after a cesarean section, you may experience soreness in the puncture area. Often the pain radiates to the lumbococcygeal region. Unpleasant sensations are relieved with analgesic medications. After a few days, the pain disappears.

In some patients, partial numbness of the lower extremities is detected. The problem occurs suddenly and also quickly goes away on its own. Numbness in the legs may occur for several months after a cesarean section. In the first days after surgery this problem more pronounced. If sensation in your legs does not return the next day after surgery, you should inform your doctor. The specialist will conduct medical examination and identify the cause of this complication.

A common problem is migraine headache. The pain affects the temporal and parietal areas. Blurred vision and tinnitus may occur. A specialist cannot always completely eliminate such pain. Some women experience pain throughout their lives due to temperature changes or changes in weather conditions. You should be aware that anesthesia can cause more complex pathology. Many patients who have undergone anesthesia subsequently suffer from long-term migraines.

Spinal anesthesia is injected into the spinal canal. Decreased sensitivity of nerve endings affects body temperature. In the first minutes after administration of the drug, the woman feels feverish. After a cesarean section, the temperature decreases periodically. After a month, this pathology disappears spontaneously.

The main problem for many women in labor is hypotension. The pathology is characterized by a sharp decrease in blood pressure. The problem occurs due to interruption of the nerve impulse. Hypotension disappears after 3–4 months. But for some mothers it remains for life. Critical conditions should be avoided through additional therapy. Helps well of this disease taking vitamin and mineral complexes.

Risks of the proposed method

Spinal pain relief has several risks. Before performing a cesarean section, the specialist must carefully examine the patient's medical history. The presence of any pathologies may affect the course of surgery.

If there is a risk of a prolonged operation, anesthesia is not used. The effect of the drug is 2 hours. In some cases, medications are used with a duration of up to four hours. If a longer surgical procedure is expected, spinal anesthesia should be abandoned.

Experience matters too medical worker administering spinal anesthesia. Not every doctor can administer the drug correctly. If the worker has little experience or practice, the effect of anesthesia may not occur or may not last long. Rarely does swelling develop due to improper administration of the drug. To avoid such a pathology, you need to consult your doctor and ask the opinion of patients who have undergone spinal anesthesia.

Rarely does an expectant mother experience allergic reaction. A few days before the cesarean section, the doctor asks the patient for allergic reactions to various drugs. A study of the reaction to the proposed active substance is also being conducted. If the expectant mother develops swelling or a rash, this drug cannot be used. But it is not always possible to conduct this research. Caesarean section is also performed on an emergency basis. To avoid unpleasant consequences, doctors monitor the patient’s condition during surgery.

Prohibitions for using the method

Spinal anesthesia is not always permitted for caesarean sections. This method pain relief has several contraindications. The following prohibitions exist:

long-term course of late toxicosis;
pathological increase in intracranial pressure;
problems with blood clotting;
heart ailments;
hypoxic injury of a child.

It is prohibited to use spinal anesthesia during long-term late toxicosis. This form of toxicosis is accompanied by loss large quantity moisture. The removal of fluid is accompanied by a decrease in the volume of cerebrospinal fluid. Minor bleeding occurs during the operation. If the patient requires a caesarean section, anesthesia is used.

A pathological increase in intracranial pressure precludes the use of many medications. Spinal analgesia affects spinal pressure. A sudden drop in pressure causes the heart rate to stop. The choice of anesthesia method is made by an anesthesiologist.

The main contraindication is reduced blood clotting. During surgery, tissues and many small vessels. If you use spinal anesthesia, there is an increased risk of large blood loss. Surgery is also excluded if you are constantly taking anticoagulant medications. These medications thin the blood. Blood loss will be significant. This pathology questions caesarean section.

Spinal anesthesia is not prescribed for problems with the cardiac system. Various heart defects and dysfunctions mitral valve exclude the use of many medications. The entire course of the operation is developed by several specialists.

In some situations, the child also suffers various ailments. Hypoxia is considered a common pathology. The disease is accompanied by a lack of oxygen. The fetus experiences oxygen starvation. In this case, a caesarean section is performed using anesthesia, since natural childbirth also becomes impossible.

Preparatory activities

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

study of the composition of blood fluid;
withdrawal of concomitant therapy;
monitoring the condition of the fetus.

A woman needs to donate blood from a vein for testing. Specialists study blood for quantitative and qualitative composition. An increased level of leukocytes and lymphocytes indicates the development of latent inflammation. A low red blood cell count can also become a problem during surgery. If the analysis is normal, the doctor proceeds to the next stage of preparation.

Some women have chronic pathologies requiring constant medication. The use of anticoagulants should be avoided. This will avoid the development of bleeding during cesarean section. Cancelled and hormone therapy. If a woman is undergoing chronic therapy, she should inform the doctor.

It is not only the woman who is subject to scrutiny. The condition of the child is also studied. For this purpose it is used ultrasound diagnostics. It is necessary to determine whether the fetus is developing correctly and whether it has any problems. The work of the child’s heart is also studied. For this study, a special device is attached to the patient’s abdomen, which responds to the work of the fetal heart. All data from it is sent to the computer. Only after all of the above measures is the method of anesthesia selected.

Characteristics of the procedure

Spinal anesthesia is not difficult. To administer the drug, the woman must lie on one side. Legs bend at the knees and press against thoracic region. In the upper part of the lumbar spine, the skin is treated with an antiseptic solution.

The anesthetic substance is drawn into a special syringe with a long thin needle. The puncture area is marked with a special napkin. The needle is inserted between the vertebrae. There is little resistance as it passes through the wall of the spinal cord. It indicates the selection of the correct site. Medicinal substance is inserted into the cavity. The needle is removed.

From this moment on, you need to monitor the patient's condition. The first sign of the onset of action of the substance is a feeling of fullness in the puncture area. Next, the woman notices loss of sensation in one leg, then the second limb is taken away. After this, my stomach goes numb. A caesarean section can be performed.

Pregnancy is a wonderful period in a woman's life. Childbirth does not always go as planned. If a patient is scheduled for a cesarean section, do not be alarmed. In this case, spinal anesthesia is often used for caesarean section.

Spinal anesthesia is one of the methods of pain relief surgical operations and manipulation. The method is also widely used during caesarean section. In this material we will talk about what this anesthesia is, how it is done and what its advantages and disadvantages are.

What it is?

Nerve endings are concentrated inside the human spinal column, which constantly send certain impulses to the brain, on which the work of the central nervous system is based. If you block the sending of these “messages”, then the brain will not perceive signals of pain or cold, touch. This is the basis of spinal anesthesia for caesarean section.

The operation involves an incision and penetration into the abdominal cavity, and therefore must be carried out using general anesthesia. mandatory. But the choice of anesthesia is a rather complicated question, because there are several types of anesthesia for this operation. Epidural and spinal anesthesia are classified as regional anesthesia.

The only difference between them is that with epidural anesthesia, drugs that block the sensitivity of nerve endings are injected into the epidural space, and with spinal anesthesia - into the subarachnoid space of the spine, that is, somewhat deeper than in the first case.

This penetration makes it possible to block nerve impulses at the level of the spinal nerve roots. Drugs administered during caesarean section have high degree purified and do not contain preservatives. Usually this is one of the anesthetics, for example, lidocaine, with the addition of opiates, for example, promedol. Recently, ketamine has been frequently used.

It is believed that spinal anesthesia is superior to epidural in terms of quality of pain relief, and also better than general anesthesia simply because recovery from it is easier, not associated with nausea and severe dizziness.

The patient is conscious during the entire operation, understands everything, can communicate with doctors, but does not feel the lower part of the body from the lower back to the tips of the toes. Wherein top part The body retains sensitivity, a woman can move her arms and head, which gives her a unique opportunity to hug her baby immediately after his birth. For this reason, in fact, many women in labor insist on spinal anesthesia.

How is it carried out?

Medicines are injected into the spine through lumbar puncture. In this case, the woman either sits, leaning forward as much as possible, or lies on her side, tilting her head to her chest. To numb the lower part of the body, the anesthesiologist inserts a puncture needle into the lumbar spine. The insertion point is located between the vertebrae. The needle itself is thinner than when using epidural anesthesia. The needle must pass through space ligamentum flavum between the vertebrae, without touching them, bypass the epidural space and penetrate the subarachnoid space filled with cerebrospinal fluid.

It should be noted that for spinal anesthesia medicines less is required than for an epidural, and the effect occurs much faster. In most cases, epidural anesthesia takes about 15 minutes to provide pain relief, and the numbness in the lower body and subsequent loss of sensation with spinal anesthesia occurs within seconds of administration.

Typically, to achieve lasting pain relief for a caesarean section, the medicine is injected into the space between two vertebrae in the range of the 2nd and 5th lumbar vertebrae. Most often, doctors choose a point between the 2nd and 3rd lumbar vertebrae.

The question of how painful it is is one that women ask very often. In most cases, the woman in labor does not experience severe pain. Depending on individual sensitivity, there may be short-term discomfort, the same as with any injection. If a woman feels discomfort, she must inform the anesthesiologist about it. The main thing is not to turn to the specialist, not to try to look at him. A woman should carry out all communication without changing her body position.

After making sure that the puncture needle gets where it is needed, the doctor administers a test dose of the medicine. After 3-5 minutes in the absence negative signs The rest is introduced in stages and in parts. During the operation, the doctor can adjust the degree of blockade by adding or decreasing the dosage of administered drugs.

When the surgeon signals that the operation is complete, the catheter is removed from the back. The woman is transferred to the intensive care ward, where she is monitored for several hours not only by obstetricians, but also by the anesthesiologist himself to ensure that recovery from anesthesia occurs without complications. It takes about 2 hours.

Possible consequences and complications

Spinal anesthesia is considered sufficient safe method pain relief. Statistics from the Russian Ministry of Health show that the probability of severe or fatal complications is 0.01%. This means that for every 10 thousand operations using such anesthesia, there was only one case of patient death, the cause of which was acute heart failure.

Many women complain of back pain and headache after operation. Post-puncture pain is a fairly common phenomenon and occurs in approximately 7-10% of women in labor. They are temporary and usually disappear completely within 2-3 months without the use of any special treatment.

Another probable complications spinal anesthesia - a drop in blood pressure in the early postoperative period. This occurs in approximately 2-3% of cases. The situation is under control and is being resolved by administering medications that increase blood pressure.

Much depends on the level of training, experience and qualifications of the anesthesiologist. An inexperienced and incompetent doctor can injure the spinal cord, the hard shells of the vertebrae, in which case various disturbances in the functioning of the central nervous system are possible, from a feeling of prolonged numbness in the limbs to paralysis. The probability of such complications, according to statistics, is low, but it exists.

In 15% of cases, a persistent analgesic effect cannot be achieved; the sensitivity of the mother in labor can be preserved to a certain extent, which is extremely undesirable for either the patient or the doctor who performs the operation.

If there is a blood clotting disorder, coagulopathy, a small hemorrhage may appear at the puncture point - a hematoma. Subarachnoid space where injections are made medications, requires precision, its injury is fraught with the development of convulsions and paralysis.

Since the doses of drugs are reduced compared to other types of anesthesia, the drugs affect the baby to a lesser extent than with epidural and general anesthesia. But there is still a slight probability of disturbances in the child’s heart rate, weakness of breathing, hypoxia, and muscle hypotension in the neonatal period.

Some women report extremely severe psychological background operations under spinal anesthesia - being conscious and understanding that it is you who is being cut on the table, as well as hearing the doctors’ conversations during the operation, is not as easy for the psyche as it seems. Particularly impressionable women, at the very beginning of the operation, begin to demand general anesthesia from doctors in order to fall asleep and wake up only when everything is completed.

Contraindications

There are two types of contraindications to such anesthesia. Some are relative, while others are absolute. Spinal anesthesia is always absolutely contraindicated in women with:

severe bleeding disorders;
infectious and inflammatory diseases skin in the area of 2-5 lumbar vertebrae, that is, where the puncture needle is supposed to be inserted;
high intracranial pressure;
spinal injuries, deformation of the spinal column;
severe heart diseases.

Relative contraindications to spinal anesthesia are:

severe psychological and emotional disorders pregnant, mental illness;
indefinite duration of the operation (if, for example, doctors assume that amputation of the uterus may be required due to placenta accreta or the woman has consented to surgical sterilization after caesarean section);
fetal death;
bleeding in a woman or suspected bleeding.

Also, the patient will be denied spinal anesthesia if the cesarean section is performed not as planned, but for emergency reasons. In this case, the child must be removed from the mother’s womb as soon as possible; for this, general (endotracheal) anesthesia is considered optimal.

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

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Types of anesthesia used for caesarean section:

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

The best type of anesthesia is the one that the anesthesiologist is fluent in. The main thing is safety. There are indications and contraindications for anesthesia, which are based on medical history, tests, severity and duration of the operation.

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

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

Pain sensitivity during epidural anesthesia ceases under the influence of drugs injected through a catheter into the epidural space of the lumbar spine. Pain impulses that are transmitted to the brain via nerve endings are blocked. Complete pain relief develops within half an hour.

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

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

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

An epidural can also have a negative effect if it is inserted incorrectly - cerebrospinal fluid enters the epidural space and causes severe pain. The anesthetic can also have a negative effect on the child - hypoxia, abnormal heart rhythm. Only serious consequences, in the form of neurological abnormalities may appear closer to two years.

Blocking the transmission of pain impulses during spinal anesthesia for caesarean section occurs through the action of analgesic drugs on the roots of the spinal nerves. The drug is injected through a thin needle into the subarachnoid space of the lumbar spinal cord. The dose of anesthetic for spinal anesthesia for caesarean section is significantly less than for epidural. The anesthesia takes effect within 5 minutes.

The consequences of spinal anesthesia during cesarean section can be headaches, low blood pressure, weakness, and poor sensitivity.

Combined spinal-epidural anesthesia

Combined anesthesia combines the spinal method with the introduction of a catheter into the epidural space. In this case, spinal anesthesia deepens and intensifies. As a result, postoperative pain relief is possible when the block is loosened.

Combined anesthesia combines the advantages of two methods, allowing to reduce the dose of the administered anesthetic.

Advantages of regional anesthesia:

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

Spinal anesthesia during caesarean section provides complete blockade of sensation in short time. Epidural anesthesia provides long-term pain relief and enhances or prolongs the effect of spinal anesthesia.

Complications:

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

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

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

General endotracheal anesthesia is used if regional anesthesia cannot be performed. General anesthesia is performed in emergency cases or when indicated for a planned caesarean section.

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

The advantages of general anesthesia are reliability and speed in preparation for emergency surgery; constant monitoring of circulatory and respiratory functions, which is important when heavy blood loss; reducing the risk of arterial hypotension; rapid relief of convulsive syndrome.

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

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

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

General anesthesia provides complete medical control of the condition of the woman and child during the operation. The anesthesia takes effect within 5 minutes. The woman in labor is unconscious, does not feel anything and does not remember.

Basic safety requirements for anesthesia:

minimal drug exposure to the child through the placenta;
preservation of the natural regulation of body functions of the mother and newborn;
maximum pain relief with minimal doses.

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

In the postoperative period, high-quality pain relief is important so that the mother can communicate calmly with the child. Non-toxic drugs are prescribed that help the woman adapt.
After epidural anesthesia, the catheter may be left in place for 24 hours. If necessary, administer through a catheter analgesics(fentanyl, pethidine, diamorphine). It is possible to use rectal anesthesia (through the rectum). After the operation, painkillers are administered intravenously or intramuscularly for two days, then, if necessary, switch to oral administration analgesics.

When prescribing painkillers after cesarean section, the breastfeeding, therefore, the most harmless drugs are prescribed.

Women often experience severe headaches after regional anesthesia. The cause of pain is the leakage of cerebrospinal fluid from the puncture.

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

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

The woman makes the decision to undergo a certain type of anesthesia together with the anesthesiologist. The doctor informs the patient about the advantages of pain relief methods and obtains consent to perform the operation and use a certain type of anesthesia.

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

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

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