home Audience 4 Anesthesia for caesarean section and its types. Indications and contraindications. Indications for general anesthesia for caesarean section

Anesthesia for caesarean section and its types. Indications and contraindications. Indications for general anesthesia for caesarean section

Caesarean section is a fairly common delivery operation. Every year the frequency of its holding increases. Knowledge about the specifics of choosing and using spinal anesthesia will help a woman prepare for the birth of a child and protect herself as much as possible from unpleasant consequences.

Indications for caesarean section and types of anesthesia

Spinal anesthesia for caesarean section most often used in the presence of the following factors: a scar on the uterus after a previous operation, breech presentation or oxygen deficiency of the fetus, anatomically narrow pelvis, complications during natural birth. In some cases, doctors take into account non-medical indicators, such as the age of the primigravida over 30 years, the risk of damage pelvic floor, the desire of a pregnant woman. Contraindications include unfavorable fetal condition (prematurity, death, deformities, prolonged oxygen starvation), clinically significant infection, protracted labor more than 24 hours.

Pregnancy causes serious changes in the body of the expectant mother, including hormonal ones. They have great importance for an anesthesiologist, because only taking them into account can a woman be given qualified assistance. As a rule, her blood pressure decreases due to a decrease in vascular resistance, the respiratory rate and tidal volume and oxygen consumption increase, and the motor activity of the stomach decreases. These changes in the functioning of the body directly affect the characteristics of anesthesia. The most commonly used methods of reducing pain during childbirth are psychoprophylaxis, systemic and regional anesthesia.

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Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!

Type of pain relief emergency surgery the anesthesiologist chooses independently according to 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 medicines inserted through a catheter into the epidural space lumbar region spine. There is a blocking of pain impulses that are transmitted to the brain via nerve endings.Complete pain relief develops within half an hour.

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

Depending on the duration of the operation, catheterization allows the use of short or short-term analgesic drugs. long acting, and, if necessary, administer 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, failure heart rate. Only serious consequences, in the form of neurological abnormalities may appear closer to two years.

Blocking the transmission of pain impulses when spinal anesthesia during 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 region 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 spinal method with insertion 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, change 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 for caesarean section provides complete blockade sensitivity 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 carried out in in case of emergency or according to indications for a planned caesarean section.

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

The advantages of general anesthesia are reliability and speed in preparation for emergency surgery; constant monitoring of circulatory and respiratory functions, which is important in case of heavy blood loss; risk reduction 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 muscle activity and nervous system. The child is often lethargic, sleepy, and lethargic. However drug-induced depression the 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:

minimum drug effects to the baby 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 required. In case of complications, the child is properly ventilated using special equipment.

IN 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, analgesics (fentanyl, pethidine, diamorphine) are administered through the catheter. 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 decision to conduct certain type The woman takes 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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Epidural anesthesia is used as the main type of pain relief. This type regional anesthesia has high efficiency, has few side effects. Let's look at it in more detail, highlighting the indications, features and contraindications.

Epidural anesthesia - indications

Epidural anesthesia for cesarean section is carried out at the request of the woman in labor. Many expectant mothers who are assigned plan section, give preference directly this type anesthesia. With such anesthesia, the woman remains conscious, hears the first cry of her baby, but feels absolutely nothing. There are also factors in the presence of which epidural anesthesia is mandatory for cesarean section. Among them:

Availability ;
high blood pressure;
liver and kidney diseases;
severe myopia;
diabetes;
contraindications to general anesthesia;
excessive labor;
pathological conditions of the uterus.

How is a caesarean section performed with epidural anesthesia?

Women preparing for surgery often ask doctors how a caesarean section is performed with epidural anesthesia. Before the beginning surgical intervention The pregnant woman sits down on the couch or lies on her side. Region spinal column where the needle is inserted is carefully treated with an antiseptic. After the onset of anesthesia, doctors make an incision in the lower abdomen, slightly above the pubis. Expanders are placed on the surgical wound, allowing access to the fetus.

After careful opening amniotic sac, doctors begin to remove the fetus. After successful completion this stage, the baby's umbilical cord is cut and a clamp is applied. The mother is given Oxytocin to remove the placenta. After this, suturing is performed. After a few months, a scar remains at the site of the suture, which is practically invisible and does not cause any inconvenience to the mother.

How is epidural anesthesia given for caesarean section?

Epidural anesthesia for caesarean section is often administered in a sitting position. In this case, the patient is asked to take a position: spread her legs at the knees, put her ankles on the bed, bend her back, tilting cervical region. An alternative is to position the woman lying on her side (usually on the right). However medical practice shows that it is easier to administer the anesthetic with the patient in a sitting position.

An anesthetic, using a special needle, is injected into the space between the wall spinal canal and the dura mater of the spinal cord (epidural space). A special, thin, sterile tube (catheter) is inserted through the needle, which is left in place to administer the anesthetic. Epidural anesthesia during a caesarean section involves dosing the drug: increasing the concentration or stopping its supply.

Is it painful to have an epidural after a caesarean section?

A procedure such as epidural anesthesia is practically painless for the patient herself. Before the puncture, doctors carry out local anesthesia. A pregnant woman may feel slight discomfort and slight pain only at the moment of puncture. Otherwise, the procedure does not cause pain and is well tolerated by pregnant women. The expectant mother's worries about the pain of such a procedure as epidural anesthesia during a caesarean section are groundless.

How long does a caesarean section last with epidural anesthesia?

A caesarean section under epidural anesthesia lasts no more than half an hour. In this case, on average, from the moment of insertion to the removal of the fetus from the abdomen, 10-15 minutes pass. The rest of the time is spent on suturing postoperative wound. At the same time, the woman is given a hormone to expel and deliver the placenta. To prevent infection, the mother is also given antibacterial drugs.

Caesarean section under epidural anesthesia - sensations

At correct implementation pain relief, the woman does not feel anything during the operation. The sensations experienced during caesarean section under epidural anesthesia are associated with the onset of action of the anesthetic. After the injection, the pregnant woman begins to notice warmth and a feeling of heaviness in her legs. Over time future mom does not feel completely bottom part torso - everything below the injection site. Mild numbness spreads throughout the body. This phenomenon may be accompanied by slight tingling, a feeling of goosebumps, which disappears after complete anesthesia.

How long does epidural anesthesia last after cesarean section?

Epidural anesthesia for caesarean section lasts about 2 hours. Immediately during this time, doctors forbid the woman to get up after the operation. With this type of anesthesia, blood flow in the lower extremities slows down. Because of this, if you try to stand up, your legs become weak and there is a high risk of falling. In addition, headaches and dizziness often occur after surgery, which worsen the well-being of the new mother.

Epidural anesthesia for caesarean section - consequences

Consequences after epidural anesthesia during cesarean section are often associated with non-compliance with contraindications to its behavior or with a violation of the pain management algorithm itself. In this case, complications can be observed both on the part of the mother and the baby. It is worth noting the consequences of epidural anesthesia for a woman in labor (during childbirth):

injury to the dura mater of the spinal cord;
decreased heart rate;
the appearance of nausea and vomiting;
allergic reaction to anesthetic.

Disorders can develop in a new mother in the postpartum period:

pain in the back and head;
violation ;
decreased sensitivity in the legs;
dysfunction of the central nervous system.

Poorly performed epidural anesthesia for caesarean section can also affect the condition of the baby:

decreased heart rate (bradycardia);
violation of the breathing process;
disturbance of the sucking reflex;
disorientation;
encephalopathy.

Back pain after epidural anesthesia for cesarean section

Epidural anesthesia for cesarean section, the consequences of which are mentioned above, often results in back pain for a woman after the birth of the child. There could be many reasons for this. Epidurit is dangerous - inflammatory process in the epidural space. This complication develops due to long stay catheter in the back or when part of it remains. In addition, pain may worsen after surgery due to an existing vertebral hernia.

Other causes of back pain are directly related to improper conduct of a procedure such as epidural anesthesia for caesarean section, and the body’s reaction to the anesthetic. Due to the lack of extensive experience, the doctor may injure the hard shell where the nerve roots. Separately, it is necessary to highlight phantom pain, which is associated directly with psychological state patients.

Headaches after epidural anesthesia for cesarean section

When talking about the consequences and complications of epidural anesthesia for caesarean section, it is necessary to highlight frequent headaches after surgery. Their appearance is associated with the effect of the anesthetic component on the body. This reaction is observed in 50% of patients who have undergone epidural analgesia. Duration painful sensations– from several hours to several weeks. Headache may also be caused by a change intracranial pressure, due to the leakage of cerebrospinal fluid into the epidural space (if the membrane of the brain is damaged).

Such situations require surgical intervention. The operation consists of repeated puncture and suction of fluid using a special device. After the manipulation, a blood patch is placed at the puncture site. The patient's blood taken from a vein is injected into the puncture site. As a result, the outflow of cerebrospinal fluid is blocked. The woman notices relief in her state of health the very next day after the procedure.

Types of anesthesia

Stages

Recovery

General anesthesia for a long time was the only type of pain relief surgical operations. Caesarean section was no exception. The woman in labor had no choice, but there was no debate in favor of one type of anesthesia or another.

Now, when there is a choice between epidural, spinal anesthesia and general anesthesia, women are at a loss as to which way is better not to feel pain. In this article we will look at the features, advantages and disadvantages of general anesthesia.

What it is?

Popularity of general anesthesia in last years decreased noticeably. But not because this type of pain relief is dangerous. In many ways, rumors about its high harm and disastrous consequences for the child are exaggerated.

Simplicity and safety simply come first. More simple view pain relief is considered epidural anesthesia, in which an anesthetic is injected into the epidural space of the spine, blocking the transmission of nerve impulses from the spinal nerves to the brain.

There is unofficial information that the recommendations of the Ministry of Health on the use of spinal anesthesia are due to the relatively inexpensive cost of funds for it, while general anesthesia requires more expensive drugs and a more complex technique.

In any case, women who choose general anesthesia for a planned caesarean section encounter a completely misunderstanding look from the anesthesiologist in the maternity hospital.

They are trying with all their might to convince them that the operation is full presence conscious patients are exactly what any woman in labor dreams of. If the patient insists, the doctors are forced to agree, because the choice of anesthesia method is the legislative right of the patient herself.

General anesthesia does not give a woman the opportunity to see the touching moment of the birth of a baby.

The woman in labor usually meets the baby only a few hours later. But you don’t have to worry about sensitivity, which may be partially preserved during epidural anesthesia - a woman under general anesthesia sleeps soundly and does not feel pain.

Most surgeons do not share the optimism of the Russian Ministry of Health regarding spinal anesthesia. Experts assure that it is easier for them to operate on a woman who is completely relaxed and unconscious than to make sure that the patient does not hear anything unnecessary, does not see what she does not need to see, and fear that she will strain the abdominal muscles, if the blockade was not complete. In addition, answering the patient’s questions at the time of the operation is also not included in the surgeon’s plans, and under local anesthesia, women are usually very sociable.

The most common general anesthesia for caesarean section is endotrecheal.

How is it done?

Many women who have had general anesthesia are quite sure that the medicine was administered intravenously to them, after which they fell asleep. In fact, endotracheal anesthesia is more labor-intensive, but patients usually do not remember its other stages.

If the decision is made to perform the operation under general anesthesia, then the woman begins to prepare for it in advance. If the operation is planned, then it is recommended to go to the hospital in advance to get everything done necessary tests and undergo premedication. If the operation is performed urgently, then general anesthesia is performed automatically, without asking the woman about her preferences. In all cases when it is necessary to deeply anesthetize and quickly remove the baby, endotracheal anesthesia is the only reasonable option.

Preparation involves taking a barbiturate drug, usually in tablet form. Premedication is necessary to ensure that the woman gets a good night's sleep the night before surgery. Deep sleep improves blood pressure levels and prevents spontaneous surges.

On the morning of the operation, an enema is given to cleanse the intestines, the pubis is shaved, and sometimes bandaging is recommended. elastic bandages lower limbs to exclude thrombosis.

In the operating room, the patient is given a dose of atropine, which should protect her heart from possible risk stops in deep medicated sleep. The surgical team then begins to prepare for the operation, and the anesthesiologist checks the blood pressure level, pulse and administers anesthetic intravenously. This drug causes falling asleep quickly. The rest happens without her participation, since she moves from different stages medicated sleep for subsequent ones and sometimes dreams, and sometimes he is simply temporarily “absent”. It all depends on the depth of anesthesia.

As soon as the doctor is sure that the patient is sleeping soundly and does not respond to touch, he inserts a special tube into the trachea of the woman in labor. She will provide the process pulmonary respiration during the operation, since the woman will not breathe on her own.

Oxygen, sometimes mixed with nitrogen, begins to flow into the patient’s body through the tube. Sometimes vapors of narcotic medications are also introduced into the inhaled mixture. The tube is connected to a ventilator.

Sometimes doses of drugs are dosed by modern dosage meters, which monitor even the slightest changes in the concentration of a particular gas and drug for drip spraying.

Endotracheal tube insertion

A woman cannot feel pain. Her sleep is very deep, any sensitivity is completely excluded.

The anesthesiologist is nearby and monitors the woman’s condition every minute. If necessary, he adds a dose of anesthetics and muscle relaxants. There is a catheter installed in the woman's vein. If necessary, any medications, which may be required by the mother's condition.

Approximately 15 minutes before the end of the operation, the surgeon notifies the anesthesiologist that support can be stopped, and from this moment a slow and gradual awakening begins. The breathing reflex returns first. This becomes the signal for the anesthesiologist to remove the tube from the trachea. After the operation, the patient is sent to the ward intensive care, where over the next few hours she will have to emerge from the state of anesthesia under the supervision of doctors.

A cesarean section is a surgical delivery in which the baby is removed through an incision abdominal wall and mother's uterus. Today this operation is completely safe and is actively used in obstetrics. You can read more about the operation in the article, but now we’ll talk about how a caesarean section is anesthetized.

Today, the following are used as anesthesia for caesarean section:

General anesthesia.
Spinal anesthesia.
Epidural anesthesia.

Spinal and epidural anesthesia is also called regional anesthesia.

General anesthesia

General endotracheal anesthesia for elective caesarean section is being performed less and less today. However, this is what is done when the operation needs to be performed urgently, and there is no time to wait for the anesthesiologist to perform regional anesthesia.

The manipulation takes place in several stages. First, a drug is injected into a woman’s vein, putting her into a medicated sleep and turning off consciousness. Then a tube is inserted into the trachea to supply a mixture of oxygen and anesthetic gas and artificial ventilation of the lungs. The effect of anesthesia, with proper administration of drugs, appears almost instantly. The woman is completely unconscious.

Advantages of general anesthesia for caesarean section

immediate action in case of urgent surgery;
low risk of falling blood pressure, stable functioning of the cardiovascular system;
complete relaxation of the mother’s body muscles, which is very convenient for the surgeon;
the possibility of timely extension of action through additional injections, control of the depth of anesthesia;
the opportunity for the mother not to see the operation if she is frightened by such a prospect (despite the fact that even with regional anesthesia, she still will not see the progress of the operation, since a screen will be installed at chest level).

Disadvantages and complications after general anesthesia

General anesthetics can influence the child. This is expressed in some oppression muscle activity, nervous and respiratory systems of the baby. As a rule, this effect is short-lived and is expressed in the fact that after extraction the child is inactive and does not scream in the first seconds.

But there are also cases of subsequent development of complications, up to hypoxic-ischemic encephalopathy; it all depends on what dose of drugs was administered to the woman and how quickly the baby was removed. However, medicine does not stand still, and every year new drugs appear that minimize negative impact per child.

Opportunity severe "departure" from anesthesia. It all depends on individual characteristics a woman’s body: some suffer from headaches, nausea and confusion for another day after surgery, while others feel great within a few hours.

Irritation and sore throat, cough - all these are the consequences of not very careful actions when installing a tracheal tube, in addition, coughing after a cesarean section gives a woman a lot of discomfort, so any tension in the abdomen causes pain.

Risk of aspiration- entry of stomach contents into respiratory system due to the fact that when the tube is inserted into the trachea, vomiting may begin.

Probability effects of drugs on cardiovascular system, as well as the occurrence of allergic reactions.

Indications

General anesthesia is performed:

during an emergency caesarean section, when there is a threat to the life of the child or mother;
if there is a likelihood of complications leading to removal of the uterus, as well as obstetric hemorrhage, for example, in the case of placenta previa;
in cases where regional anesthesia is impossible for one reason or another, for example, with a mother high degree obesity or spinal injury, low blood pressure, bleeding and so on.

So, general anesthesia is still quite popular today due to the fact that the hospital does not always have an anesthesiologist capable of performing regional anesthesia or the drugs necessary for this are available. In addition, new drugs are being developed that make general anesthesia increasingly safer for the baby and easily tolerated for the mother.

Regional anesthesia

Anesthesia aimed at local anesthesia is called regional. This includes spinal and epidural. The mechanism of these manipulations is very similar: a puncture is made in lumbar region spine, and through it the supply of anesthetics. As a result of both spinal and epidural anesthesia for caesarean section, pain is relieved in the lower part of the woman's body, while she remains conscious.

The main difference between the types of regional anesthesia for cesarean section is the depth of the puncture and the dose of anesthetics. Let's take a closer look.

Spinal anesthesia

Spinal or, as it is also called, spinal anesthesia for caesarean section can be performed either routinely or urgently, provided that doctors have about 10 minutes left.

The manipulation mechanism is as follows:

A woman needs to sit on the couch with her hands on her knees and arch her back, or lie on her side and pull her legs towards her stomach in order to ensure maximum possible access to the spine;
The woman in labor will be treated disinfectant solution the area around the upcoming puncture;
The anesthesiologist gives an injection of anesthetic so that the skin and subcutaneous fat lost sensitivity;
A long, thin needle is used to puncture (puncture), an anesthetic is injected into the cerebrospinal fluid (between the vertebrae below the level of the spinal cord);
The needle is removed from the puncture, a sterile napkin is applied and secured with an adhesive plaster.

Pain relief occurs almost instantly. The woman does not feel any pain or tactile sensations.

pros

the risk of drug exposure to the child is completely eliminated;
fast action within a few minutes is significant indicator, since along with pain relief the woman’s pressure level in the lower half of the body drops, which leads to hypoxia of the baby, therefore, the sooner he is brought into the world after the start of pain relief, the better;
absolute anesthesia, the risk of partial or insufficient anesthesia is extremely small, in addition, spinal anesthesia for caesarean section provides sufficient muscle relaxation, which facilitates the surgeon’s work;
a small dose of anesthetics compared to epidural anesthesia. Due to this, if drugs accidentally enter the bloodstream, the risk of toxic poisoning;
due to the fact that the woman is conscious, there are usually no breathing problems. If necessary, an oxygen mask can be used;
the woman in labor hears the first cry of her baby and can immediately put him to her breast;
For an anesthesiologist, manipulation of spinal anesthesia during cesarean section requires less effort and qualifications than, for example, during epidural. Consequently, there is less risk of complications or unsuccessful puncture;

Disadvantages and complications after spinal anesthesia

a sharp drop in blood pressure (BP). Due to this inevitable factor in the use of spinal anesthesia, a series of preliminary preventive measures. As a rule, a woman is given drugs that increase blood pressure, but they can negatively affect the child’s nervous system, since, by raising the mother’s blood pressure level to an acceptable level, they will cause increased blood pressure in the baby;
limited exposure time. If with epidural anesthesia it is possible to add anesthetics as needed, then in this case the drugs are administered once - before the start of the operation. If something goes wrong and the operation takes longer than planned, the woman will be urgently transferred to general anesthesia. However, today drugs are used whose effects last up to 2 hours;
high risk of neurological complications associated with the development of headaches.

Epidural anesthesia

Mechanism The manipulation generally repeats spinal anesthesia, but the needle is inserted into the space between the wall of the spinal canal and the hard wall of the spinal cord - into the epidural space, where the nerve roots exit.

A very thin rubber tube is passed along the needle - catheter. The needle is removed from the puncture, but the catheter remains; painkillers are subsequently supplied through it.

The effect of anesthesia develops gradually within 20 minutes after the start of drug administration.

pros

the woman in labor is conscious and can see her baby immediately after birth;
the decrease in blood pressure occurs gradually, which makes it possible to maintain it at normal levels using preventive measures;
the ability to prolong pain relief if the operation is prolonged, as well as postoperative period. Additionally, if an epidural was used for labor that progressed to an emergency cesarean section, it will continue to be used during surgery.

Disadvantages and complications after epidural anesthesia

if a large dose of anesthetics accidentally enters the bloodstream, toxic poisoning may develop, including convulsions and death;
sometimes epidural anesthesia does not work at all or works partially, for example, numbing only the left or right side;
a complex manipulation that requires a certain level of skill from the anesthesiologist. This also determines the high risk of complications due to errors in execution;
possibility of developing a spinal block. A complication occurs when the puncture is performed incorrectly and anesthetics are injected under the arachnoid membrane of the spinal cord. In the event that it was entered high dose drugs, and help is not provided on time, the woman may experience respiratory arrest, and then cardiac arrest;
the effect of drugs on the child;
Due to the late effect of anesthetics, the start of the operation is delayed by an average of 20 minutes. A drop in blood pressure during this time can lead to prolonged fetal hypoxia.

Contraindications for regional anesthesia for caesarean section

spinal deformities and injuries;
low blood pressure;
inflammation at the puncture site;
intrauterine fetal hypoxia;
existing or suspected bleeding in the mother.

Common complications of regional anesthesia

1. When puncturing the dura mater of the spinal cord cerebrospinal fluid may spill into the epidural space. This complication after a cesarean section is characterized by severe, prolonged pain in the back and head. As a rule, it is first carried out drug treatment, and if it does not produce results, a so-called “blood patch” is done.

The essence of the manipulation is that a puncture is performed again, and the woman’s own blood is injected into the epidural space in order to “seal” the puncture of the spinal membrane. This procedure usually produces quick, noticeable results.

2. Probability of development long-term positional compression syndrome. This complication after anesthesia is due to the fact that after the operation the woman in labor does not feel her legs for some time. Sometimes it happens that when transferring her from the gurney to the bed, her leg gets twisted.

If the medical staff did not notice this and the leg is in an unnatural position long time, no blood flows to it, and this is fraught with the development of serious consequences.

After the limb is returned to its normal position, shock and swelling will begin to develop, all accompanied by pain and difficulty moving.

If you are having regional anesthesia for a caesarean section, be sure to reaffirm to yourself the need to make sure that you are placed on the bed correctly. This way you will save yourself from months of suffering and the use of narcotic painkillers.

Complications of regional anesthesia for a child

So, what is the danger of lowering the mother’s blood pressure during regional anesthesia for cesarean section? The fact is that in such a situation, the blood flow of the placenta is disrupted, and, as a result, the child develops hypoxia. Hypoxia (or oxygen deprivation) can cause damage white matter brain, that is, deviations in the development of the central nervous system with all the ensuing consequences.

It is noteworthy that a newborn can show a high Apgar score, and the results of hypoxia will appear much later - by 2-3 years.

As you can see, all types of anesthesia have their advantages and disadvantages. In the article we indicated background information so that you can imagine what anesthesia is for a caesarean section.

However, a lot depends on your individual characteristics and medical qualifications. personnel, the drugs used and many other factors that determine the outcome of the operation in general, and the use of anesthesia in particular. In addition, science does not stand still - new methods and drugs are constantly appearing.

Remember that you yourself can choose the type of anesthesia for a planned caesarean section, provided that your choice does not contradict objective contraindications. In order to make the right decision you should get advice qualified specialist, talk to the doctor who is caring for your pregnancy and an anesthesiologist.

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