Anesthesia for caesarean section consequences. What is the best anesthesia for caesarean section? How is Spinal Anesthesia Performed for a Cesarean Section?

First, let's be clear that you have a choice. Because if you need an emergency caesarean section, a woman in labor usually has no choice. If something went wrong during childbirth, and we are talking about saving the life of the mother and child, doctors use the option of anesthesia that is preferable here and now.

But you are preparing for a planned caesarean section and still have a choice. You can watch a video about anesthesia before choosing, find out what an epidural is, does it hurt and is it better than under general anesthesia and make the right and safe choice. Therefore, we will dwell in detail on each of the possible types of anesthesia offered by modern medicine.

Which anesthesia is better for caesarean section

There are three types of anesthesia:

• Epidural anesthesia for caesarean section. It is performed mainly during a planned operation. The anesthesiologist cleans the back with a strong cooling solution and inserts a needle into the spine. Then the needle is removed, and a thin catheter is placed in its place, through which the drug enters the spinal cord. It causes an almost complete loss of sensation in the body from the chest to the knees, which can be observed within a few hours after childbirth.
• Spinal anesthesia for caesarean section. This type of anesthesia is used mainly in emergency cases. Its difference from epidural anesthesia lies in the fact that the drug is injected into the cerebrospinal fluid and in smaller doses. At the same time, the woman is also in a waking state, and does not feel pain. But he needs constant correction of his condition due to the possibility of reducing the analgesic effect and an oxygen mask.
• General anesthesia. The patient is put into a state of artificial sleep and wakes up when everything is over. But the risk of complications of general anesthesia is significantly higher than other types of anesthesia.

Each anesthesia for caesarean section has its own advantages and disadvantages. Therefore, it is very important to discuss in advance with the doctor who will take care of your childbirth, the use of this or that technology.

Indications for the appointment of epidural anesthesia for caesarean section

This type of anesthesia may not be prescribed for everyone. If a woman has low blood pressure, there is a risk of blood loss, there is damage to the nervous system, or severe spinal deformities, epidural anesthesia will not be performed. But doctors refer these contraindications rather to general ones, which prohibit the use of other drugs. Therefore, more attention is paid to those conditions when epidural anesthesia is vital.

• Preeclampsia or impaired placental blood flow. When it occurs, oxygen starvation of the fetus occurs, which can lead to severe malformations of its development. Epidural anesthesia improves placental and renal blood flow.
• Pathologies of the cardiovascular system. A woman is forbidden to give birth herself because of the risk of complications due to the high load on the heart. Anesthesia allows the heart to work at its usual rhythm.

One of the dangers of epidural anesthesia lies in the possibility of a drop in the blood pressure of the woman in labor. But it is quickly corrected by the introduction of appropriate drugs. Another risk is the incorrect position of the child or the oppression of the fetus. But if a cesarean section is performed as planned, and not urgently, such situations are extremely rare.

If we talk about the sensations during and after the introduction of anesthesia, then before the start of the operation they will not be pleasant, but not painful either. During the insertion of the needle, the doctor may catch the spinal nerve, which sometimes causes leg cramps or numbness. All these are normal manifestations of the procedure, which should not be feared. In rare cases, paralysis, damage to the spinal nerve, the occurrence of infectious diseases are possible.

General anesthesia or epidural anesthesia for caesarean section - which is better?

Modern medicine offers epidural anesthesia as the best alternative to general anesthesia. The risk from performing the latter is ten times higher than from local anesthesia. Only at first glance it seems that it is better to fall asleep for a couple of hours, and then wake up and happily hug your baby. During the period of deep sleep, sudden changes in pressure and disturbances in the heart rhythm of the woman in labor are possible, which during her wakefulness are detected much more quickly. And they are also quickly eliminated without a significant threat to the life and health of two patients.

Choose your choice of anesthesia for caesarean section very carefully. And do it not with your friends or with your husband, but with your doctor. After all, a doctor is needed not only to tell you about proper nutrition during pregnancy. And in order to preserve the health of a young mother and baby and make the happiness of motherhood truly complete!

Epidural anesthesia for caesarean section: video

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Approximately 20% of babies are born in a non-standard way - through a surgical incision in the anterior wall of the abdomen and uterus. Such an operation is called a caesarean section and has been practiced for more than a dozen years. According to what indications and for how long a caesarean is performed, how the procedure is carried out, under what anesthesia - these and many other questions prevent expectant mothers from sleeping peacefully. We will try to present all the most interesting and important information here.

Any surgical intervention, even the most insignificant, to a certain extent carries a potential danger to the health (and sometimes life) of the patient. That is why a pregnant woman cannot “order” a caesarean section to the 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 their efficiency and painlessness, from a medical point of view, natural delivery will always be a priority.

There are absolute and relative reasons for the operation.

Absolute readings:

1. The first child was born by caesarean and independent childbirth can lead to complications.
2. The baby is located across the uterus or "sat down" on the ass.
3. The mother-to-be has been diagnosed with an illness or condition that could cause the baby to die during childbirth.
4. The baby's head is too big and won't fit through the pelvic bones.
5. Severe late toxicosis.
6. Multiple pregnancy.

Relative readings:

1. Anatomically non-standard development of the mother's skeleton (for example, a narrow pelvis, not intended for natural delivery).
2. Big baby with presentation.
3. Pregnancy beyond the expected due date.
4. Varicose veins of the genital tract in a pregnant woman.
5. Pathology of the development of the uterus.
6. Doubtful condition of scars from previous operations on the uterus.
7. Acute and chronic diseases of the mother, which can have a negative impact on the course of childbirth or harm the woman in labor (high degree of myopia, arterial hypertension).
8. late birth.
9. Artificial insemination, miscarriages or stillbirths in the past.
10. Severe swelling.

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

1. Severe infectious diseases in the expectant mother.
2. The pregnant woman is HIV-infected.
3. During prenatal diagnosis, symphysitis was detected (an excessive increase in cartilage in the area of ​​​​the pubic joint).
4. Shortly before birth, intrauterine fetal hypoxia was established.

Caesarean section: contraindications for surgery

Artificial childbirth is not carried out if:

• the child died in the womb;
• the baby was diagnosed with congenital malformations incompatible with life;
• infection of the skin and genital organs of the mother occurred.

In all the situations listed above, under conditions of caesarean section, the risk of developing sepsis and peritonitis sharply increases due to the penetration of infection into the blood.

How many weeks is a caesarean section

A planned caesarean section is prescribed during pregnancy, and only the doctor can decide on the final date of the operation. The optimal time to start the procedure is the first contractions. In order not to miss a crucial moment, the expectant mother goes to the hospital 1 - 2 weeks before the due date.

A planned caesarean section is prescribed no earlier than 37 weeks of pregnancy. Which week a caesarean is done depends on the decision of the specialists. When choosing a day for surgical intervention, the doctor always focuses on the expected date of the baby's birth. To prevent the development of intrauterine hypoxia, a caesarean section is performed at a period of 38-39 weeks.

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

How to do a caesarean: preparatory stage

The doctor will inform the woman in labor about the necessary preparations for the operation. 12 hours before the procedure, you need to refrain from eating and 5 hours from drinking. An enema is given just before a caesarean section. There is little pleasant, but the risk of infection during childbirth is practically absent, and the rehabilitation process will go faster.

During the operation, the integrity of the abdominal muscles is broken by a large incision. The first time after artificial birth, even the slightest tension in the abdomen will cause tangible discomfort, despite medical anesthesia. And the enema given before the operation will save the young mother from the pain when trying to go to the toilet "in a big way" in the first days after the cesarean, since the intestines will be relatively emptied.

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

How is a caesarean section done: the sequence of the procedure

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

When the painkillers take effect, the doctor will make an incision in the pregnant woman's abdomen. Most often, this manipulation is carried out according to the Pfannestiel method - the incision runs along the pubic hair growth line. In emergency cases, when every second counts, a lower median incision is performed - from the navel along the midline down to the pubis. During a planned operation, the uterus is cut, like the abdomen, horizontally. A vertical incision is performed with multiple pregnancies or pathological attachment of the placenta.

Through the incision, the doctor removes the baby from the uterus, separating the placenta. After the newborn is placed on the chest of a happy mother or handed over to the father. 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 contract faster. The operation is completed by suturing the cut tissues with a self-absorbable 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 newly-made 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, a woman is lifted out of bed immediately a few hours after the anesthesia has ceased to work. Walking is the best prevention of blockage of blood vessels. It is strictly forbidden to lift anything heavy.

Who does a caesarean in the maternity hospital depends on the policy of the medical institution and on the state of health of the woman in labor and her baby. Usually these are 2 obstetrician-gynecologists, 1 anesthesiologist, 1 midwife who takes the child and 1 neonatologist.

Anesthesia for caesarean section

Artificial childbirth is a serious abdominal operation and is performed 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 a woman in labor of sensitivity by this method, an injection is made under the spine in the lumbar region - there are spinal nerves. 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 well aware of everything that happens to her, but she does not feel the lower part of the body. The woman is immobilized from the waist down and will not be in much pain when doctors make incisions to remove the baby.

Among other "pluses" of this type of anesthesia, we note:

• ideal for women who suffer from bronchial asthma;
• does not distort the work of the cardiovascular system, since the anesthetic drug is dosed into the body;
• thanks to this injection, the administration of opioid anesthetics after surgery is allowed.

Despite the clear 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 anesthetic;
• transverse presentation of the child;
• scar on the uterus;
• the presence of inflamed or purulent zones in the puncture area;
• curvature of the spine.

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

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

If during caesarean section anesthesia is done in the form of epidural anesthesia, the pregnant woman must be warned about the consequences of such a step: back pain and headaches, tremor of the lower extremities, 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 membrane. The injection is made strictly in a certain place (between 2 and 3 or 3 or 4 vertebrae) so as not to damage the spinal cord. For spinal anesthesia with cesarean, a smaller volume of anesthetic is required than in the previous version.

Benefits of spinal anesthesia:

• complete loss of sensation;
• the rapid onset of the effect - a few minutes after the anesthetic enters the body;
• low likelihood of complications due to the exact injection site;
• absence of unforeseen reactions in case of improper injection.

Disadvantages of spinal anesthesia:

• short duration - the injection lasts no more than 2 hours;
• the likelihood of a decrease in blood pressure if the anesthetic is administered too quickly;
• the risk of developing a headache that persists on average up to 3 days after surgery.

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

• rash or pustular formations at the site of the proposed injection;
• circulatory disorders and blood clotting;
• blood poisoning;
• diseases of a neurological nature;
• developmental pathology of the spine.

General anesthesia for caesarean section

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

General anesthesia for caesarean section is done in such cases:

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

Benefits of general anesthesia:

• almost instantaneous loss of sensation.
• no interruptions in the work of the cardiovascular system;
• lack of difficulties in the implementation of anesthesia.

Disadvantages of general anesthesia:

• the likelihood of penetration of gastric juice into the lungs with the subsequent development of pneumonia;
• the likelihood of a detrimental effect of the anesthetic on the central nervous system of the newborn;
• the risk of developing hypoxia in the mother.

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 need to trust only professionals.

Possible complications after caesarean section

During the birth of a child, a woman experiences an enormous load and is subjected to severe stress, regardless of whether it is a natural or artificial birth. Surgery is not very long, but it can result in some complications for the woman in labor, including:

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

Not only a woman, but also a newborn child can 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 due date. In this regard, it will be difficult for the baby to adapt to the outside world. In addition, practice shows that "cesareans" get sick more often than babies born on their own;
• anesthesia, even the weakest, affects the baby as well. 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.

Recovery period after caesarean section

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

1. On the first day after cesarean, only drink is allowed. The choice is limited to non-carbonated water at room temperature. The next day, you can refresh yourself with yogurt, porridge, sweet tea and lean meat. A light diet should be followed for about a week after surgery.
2. After surgery, the seam hurts for some time, so the woman is prescribed painkillers. As you recover, the unpleasant sensations weaken every day.
3. For 2 to 3 weeks after a cesarean, a woman will have to intensively observe intimate hygiene, since at this time she will still be disturbed by spotting. Then they will completely disappear.
4. Approximately 2 weeks after the birth of the child, the seam on the abdomen should be regularly treated to prevent infection and decay. At the same time, the state of health is overshadowed by severe cutting pains in the incision area. The tissue at the site of stitching first turns red, and later, when the scarring process begins, it 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.
5. 2 months after the operation, a woman is recommended to gradually join the sport. Intensive training is allowed only after 6 months. Sexual life is best resumed 1 month after childbirth.

Recently, 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 of natural delivery. However, the risk of complications is present in both spontaneous and operative childbirth. Before finally deciding how the little man will come into this world, you need to carefully listen to the arguments of your doctor about the "pluses" and "minuses" of a caesarean section.

How is a caesarean section done? Video

If there is a planned time to prepare the woman in labor for it, the woman herself can choose the method of anesthesia, but in most cases it is individually determined by the anesthesiologist. Today, the following methods of anesthesia are used for caesarean section:

A surgical operation on the abdominal cavity, due to which a child can be born by removing it from the mother's abdomen, is called a caesarean section. It is carried out when natural childbirth is contraindicated and poses a threat to both the health of the mother and the child.

If the caesarean section is planned and there is time to prepare the woman in labor for it, the woman herself can choose the method of anesthesia, but in most cases it is individually determined by the anesthesiologist. Today, the following methods of anesthesia are used for caesarean section:

• spinal;
• general.

When choosing one of them, you should consider the following factors:

• do you want to be unconscious for the duration of the operation and wake up in the ward as a happy mother;
• or you have a desire to “be present” at the operation.

None of the types of anesthesia is desirable for a child, but nevertheless, the greatest risk of complications is associated with general anesthesia, when several medications are injected into the mother's body at once.

Let us consider in more detail each method of anesthesia for caesarean section.

Epidural anesthesia during caesarean section

Anesthesia, in which an anesthetic is injected into the lumbar region of the back (epidural space between the vertebrae) of the expectant mother, is called epidural.

The advantages of epidural anesthesia during caesarean section are, first of all, that the woman in labor is constantly conscious, so that she can observe the birth of her child. Also, due to the fact that the anesthetic (painkiller) gains strength gradually, the stability of the cardiovascular system is maintained. To some extent, even the ability to move is preserved. Epidural anesthesia is indispensable during childbirth, which take place with complications and require a long duration. Only such anesthesia is acceptable for women in labor suffering from bronchial asthma, since with it the airways are not irritated.

The disadvantages of epidural anesthesia are that the anesthetic may be administered incorrectly or seizures may occur with a large dose.

Epidural anesthesia should only be performed by an experienced specialist, since there is a risk of frequent epidural blocks, which can lead to subsequent frequent severe headaches.

Improper administration of epidural anesthesia is fraught with neurological complications.

Indicators for the use of epidural anesthesia for caesarean section is the risk of changes in blood pressure.

Spinal (spinal) anesthesia for caesarean section

The essence of such anesthesia is the introduction of an anesthetic into the lumbar spine between the vertebrae in the subarachnoid space. When it is carried out, the dense membrane surrounding the spinal cord is pierced (with epidural anesthesia, the needle is inserted a little deeper than with spinal anesthesia).

It is most suitable for caesarean section, among its advantages are the following:

• lack of systemic toxicity;
• excellent analgesic effect;
• the time after the introduction of anesthesia and before the start of the operation is approximately two minutes;
• spinal anesthesia is much easier to introduce than epidural anesthesia, because it very accurately determines the place for inserting a needle.

But also with such anesthesia, there are disadvantages, namely:

• limited time of action (on average, the anesthetic lasts two hours);
• a sharp onset of the action of an anesthetic, which can provoke a decrease in blood pressure;
• as well as with epidural anesthesia, post-puncture headaches may occur;
• the development of neurological complications is possible (in cases where the administered dose of anesthetic was insufficient, repeated injections should not be made. It is necessary either to re-insert the catheter or apply a different method of anesthesia).

Spinal anesthesia is contraindicated in premature placental abruption.

General anesthesia for caesarean section

This type of anesthesia is used in the diagnosis of fetal hypoxia or in the presence of contraindications for regional (epidural or spinal) anesthesia, which may include severe pathologies, increased intracranial pressure, or prenatal hemorrhage.

Its essence is that due to drug exposure, the woman in labor experiences a “turn-off of consciousness” and a complete loss of sensitivity.

The advantages of general anesthesia for cesarean section can be called the fact that it is easier for a woman to tolerate and guarantees complete pain relief when used correctly. It should also be taken into account that anesthesia begins to act very quickly, and this is very important in cases where the operation is urgent and requires immediate implementation. With general anesthesia, the woman in labor is unconscious, and the muscles are completely relaxed, which creates excellent conditions for the surgeon to work.

Also, with general anesthesia, stable work of the cardiovascular system is maintained, since there is no decrease in pressure (as in natural childbirth).

This method of anesthesia is preferred by most anesthesiologists, but it also has disadvantages, namely:

• the development of oxygen deficiency (hypoxia) in a woman;
• there is a risk of impossibility of tracheal intubation (insertion of a disposable plastic tube into it), which, in turn, makes it impossible to connect a woman in labor to an artificial respiration apparatus;
• aspiration may occur (penetration of foreign materials into the respiratory tract, in this case we mean the entry of the contents of the stomach into the lungs of a woman);
• with general anesthesia, depression of the central nervous system of the child is observed, which is associated with the penetration of the narcotic substances used during the procedure through the placenta (this should be especially taken into account in premature pregnancies or if there is too much time between the introduction of general anesthesia and the onset of the birth itself. But you should not panic, since modern doctors use anesthetic drugs with minimal effect on the child's central nervous system - with the right individual selection of drugs, general anesthesia does not threaten with serious consequences).

When is general anesthesia indicated for caesarean section?

Indicators for the use of general anesthesia for caesarean section are:

• threatening condition of the fetus;
• the need for immediate delivery;
• cases when regional anesthesia is contraindicated (for example, the discovery of bleeding in a pregnant woman);
• with the independent refusal of the woman in labor from epidural or spinal anesthesia;
• morbid obesity of the expectant mother.

But it is worth noting the fact that epidural anesthesia is less dangerous for the child than general anesthesia, in which anesthetic drugs are used that act on the brain.

Specially for Anna Zhirko

The operation of cesarean section is performed exclusively under anesthesia, since it is abdominal. Pain relief of surgical intervention is discussed in advance if the operation is planned. And a woman can choose one or another type of anesthesia, but not always. Sometimes only a doctor should do this. In this article, we will talk about what options exist, how they differ, what are their advantages and disadvantages, and also describe situations in which a woman cannot make an independent choice.

What is taken into account when choosing?

The operation includes dissection of the anterior abdominal wall, uterus, removal of the child and manual separation of the placenta, after which internal sutures are first applied to the uterus, and then external to the incision in the peritoneum. Surgical intervention lasts from 20 minutes to an hour (in especially severe and complex cases), and therefore under local superficial anesthesia, such an operation cannot be performed.

Today, when performing a caesarean section, two types of anesthesia are used - epidural (and, as a variation, spinal or dorsal) and general anesthesia. With an emergency caesarean section, which is performed to save the life of the child and mother, if something went wrong in natural childbirth, general anesthesia is usually used by default. The question of choosing the method of anesthesia for caesarean section is usually decided in advance only when the operation is planned in advance.

In this case, doctors evaluate a lot of factors. First of all, the condition of the pregnant woman and the fetus, the possible effect of medications used for pain relief on the child and mother. It is necessary to take into account certain contraindications and indications for different types of anesthesia. Regional (epidural) anesthesia has contraindications, while general anesthesia has no contraindications.

Epidural anesthesia

Today, up to 95% of all caesarean sections in Russian maternity hospitals are anesthetized in this way. The essence of the method lies in the fact that the introduction of a drug, which leads to a loss of pain sensitivity in the lower body, is done through a thin catheter inserted into the epidural space of the spine.

As a result of this introduction, the transmission of nerve impulses to the brain through the spinal canal is blocked. When such a “gap” occurs in the CNS chain, the brain simply does not perceive and does not associate the ongoing violation of tissue integrity during surgery as a reason for activating the pain center.

The scope of such anesthesia is quite wide, but in natural childbirth for pain relief and in caesarean section, such anesthesia is considered less dangerous than in anesthesia of the cervical spine or arms for operations on the upper body.

As a rule, anesthesiologists administer special, carefully purified solutions that were originally intended exclusively for such use. To relieve pain in natural childbirth, lidocaine, ropivacaine can be administered. But for a caesarean section, such anesthesia will not be enough. A certain amount of opiates, such as promedol, morphine, or buprenorphine, may be given at the same time as lidocaine. Ketamine is often used.

The dosage of substances is determined by the anesthetist, taking into account the state of health, weight and age of the woman, but spinal anesthesia of opiates always requires less than intravenous anesthesia, and the effect can be achieved longer.

How do they do it?

The woman lies on her side with her back bare, her legs slightly tucked in and her shoulders forward. The anesthesiologist uses one of the existing methods to determine exactly where the catheter should be inserted. For this, an air-filled syringe is usually used, which is connected to the catheter. If the piston encounters significant resistance, then the catheter is in the ligamentous space. If the resistance is suddenly lost, we can talk about the correct detection of the epidural space, where drugs will have to be slowly injected.

The introduction is stepwise. This means that the doctor first administers a test dose. After three minutes, the condition is assessed, and if the first signs of anesthesia, loss of sensitivity appear, the remaining parts of the dosage prescribed for a particular woman are administered in several steps.

A woman may first ask the anesthesiologist, who will definitely meet with her the day before the operation, the name of the drugs that are planned to be administered. But it is better not to ask about the dosage, since its calculation is extremely complex and based on numerous factors.

The operation begins after there is a complete blockade of the lower body. A screen is installed in front of the woman's face so that she does not see the manipulations of the surgeons. Throughout the operation, a woman in labor can communicate with doctors, see the main moment - the first breath and the first cry of her baby.

After that, the doctors will start suturing, and the baby may well be left next to the mother for a few minutes so that she can admire the long-awaited baby to her heart's content.

Advantages and disadvantages

Complications after such anesthesia are possible, but in practice they occur only in 1 case per 50 thousand births. What can be unexpected and negative manifestations? It happens that the blockade of nerve endings does not occur, the sensitivity is preserved, and this, according to statistics, happens in one woman in 50 operations. In this case, the anesthesiologist urgently decides on general anesthesia.

If a woman has problems with blood clotting, then a hematoma may develop at the site of the catheter. The anesthesiologist may accidentally puncture the dura mater when inserting the needle, which can lead to leakage of cerebrospinal fluid and subsequent problems with severe headaches.

Inaccurate movements of an inexperienced doctor can lead to injury to the subarachnoid space, as well as to the development of paralysis. Opponents of general anesthesia say that during epidural anesthesia, the drugs administered do not have any effect on the child, in contrast to total drug sleep, in which the woman in labor is immersed during general anesthesia. This is not true. Medicines that are administered to block pain can cause a decrease in the heart rate in the baby, as well as a state of hypoxia or respiratory failure in him after birth.

Many women in labor complain of back pain and numbness of the legs for quite a long time after surgery. Officially, it is considered that the time to exit from spinal anesthesia is a period of about 2 hours. In practice, the output is longer.

The advantages of epidural anesthesia include the stability of the heart and blood vessels of a woman throughout the operation. A significant disadvantage is that not all nerve receptors are blocked. A woman will not feel pain directly, but at times she will still have to go through unpleasant sensations.

Many women are wary of such anesthesia, because they are not even afraid of complications, but the very need to be present at their own operation - psychologically it is quite difficult.

Often, women consider epidural anesthesia and spinal anesthesia to be the same type. In fact, there is no difference for the patient, in both cases the drug is injected into the back. But with a spinal injection, it is deeper, and therefore the sensitivity decreases more effectively.

If the question is fundamental, specify where the doctor plans to do anesthesia - in the epidural space of the spine or in the subarachnoid space. Otherwise, everything will proceed exactly the same.

General anesthesia

Previously, it was the only type of anesthesia for caesarean section. Now general anesthesia is used less and less. This is officially explained by the fact that general anesthesia harms the child and the woman. It is unofficially known that the cost of drugs for spinal or epidural anesthesia is lower, and therefore the Ministry of Health in Russia strongly recommends that anesthesiologists do their best to convince women to choose regional anesthesia. This question is complex and ambiguous.

General anesthesia for CS surgery is usually endotracheal. With him, the woman does not feel anything, does not hear or see, she sleeps peacefully throughout the entire surgical intervention, without worrying herself, and without pulling questions from the doctors who help her baby be born.

How do they do it?

Preparation for such anesthesia begins in advance. In the evening, on the eve of the day for which the operation is scheduled, premedication measures are taken - the woman needs to relax, sleep well, and therefore she is prescribed a dose of barbiturates or other serious sedatives before going to bed.

The next day, already in the operating room, a dose of atropine is administered to the woman in order to exclude cardiac arrest at the time of being in drug sleep. Analgesics are administered intravenously. At this stage, the woman, not having time to be afraid of what is happening, falls asleep.

When she is already in a state of sleep, a special tube will be inserted into her trachea. Intubation is necessary to ensure pulmonary breathing. Oxygen mixed with nitrogen, and sometimes narcotic fumes, will be supplied through the tube to the lungs throughout the operation.

The sleep will be deep, the anesthesiologist will monitor the condition of the woman in labor, measure pressure, pulse, and other indicators throughout the intervention. Doses of supportive medications administered will be increased or decreased as needed.

Shortly before the end of the operation, at the surgeon's command, the anesthesiologist begins to reduce the doses of muscle relaxants and anesthetics, narcotic substances. When the doses are "zeroed", the process of smooth awakening begins. At this stage, the tube is removed from the trachea, since the ability to breathe independently, without a ventilator, returns one of the first.

Advantages and disadvantages

Psychologically, general anesthesia is much more comfortable than regional anesthesia. The woman does not see what is happening and does not hear the conversations of doctors, who can sometimes shock anyone, and even more so about a patient lying on the operating table. A woman comes out of a state of relaxation and lethargy quite easily, but finally she leaves anesthesia only 3-4 days later. The final outcome is considered to be the complete cessation of the effect of anesthesia at all levels of physiological and biochemical processes in the body.

A big plus is the complete absence of contraindications, that is, this method is used for everyone who needs surgical intervention, without looking back at possible negative factors. The quality of anesthesia is excellent.

No sensations - neither pleasant nor painful women will feel. Possible complications of endotracheal anesthesia include possible injuries of the larynx, tongue, teeth (at the time of insertion and withdrawal of the tube), laryngospasm, and the development of an individual allergic reaction. Quite often, after such anesthesia, women have a sore throat for several days, a dry cough is observed (which is especially painful with fresh stitches on the stomach!).

If a woman decides to choose general anesthesia, she must understand that she will not meet the child immediately. She will be able to see the baby only after a few hours, when she will be transferred from the intensive care unit, where all operated women in labor are placed, to the postpartum one.

However, in some situations this issue is resolved on the spot - a woman can ask the operating team to show her the baby immediately after she comes to her senses. True, whether the newly-made mother herself will remember this moment or not, no one will guarantee.

When the question is decided only by a doctor?

If a woman who is about to have a planned caesarean section is set up for a certain type of anesthesia, she can inform her doctor about this, who will definitely pass the information on to the anesthesiologist. The woman signs an informed consent stating that she agrees to epidural anesthesia or writes a refusal of regional anesthesia.

The pregnant woman should not indicate the reasons why the decision was made in favor of general anesthesia. She generally may not justify her decision even in a conversation with a doctor.

By law, in the event of a written refusal of a woman in labor from epidural or spinal anesthesia, general anesthesia is automatically used for her. There is no second solution here. But the opposite situation, when a woman would like to be conscious during an operation, can turn around in different ways.

Epidural anesthesia has its contraindications. And no matter how a woman begs the doctor to make an angle in her back before the operation, the request will be denied if:

• previously had injuries or there are spinal deformities;
• there are signs of inflammation in the area of ​​\u200b\u200bthe intended introduction of the needle;
• a woman in labor has low and low blood pressure;
• the woman has started bleeding or there is a suspicion of bleeding that has begun;
• there is a state of fetal hypoxia.

For women with such features, general anesthesia is considered the best.

They will not ask the patient's opinion about the preferred type of anesthesia, and if there is a prolapse of umbilical cord loops, if the woman has a systemic infection, if necessary, remove the uterus after removing the baby (according to indications). Such women in labor are also given only general anesthesia. Other options are not even considered.

Hi friends! This is Lena Zhabinskaya! Surgery requires mandatory pain relief. Initially, mothers were offered only general anesthesia, meanwhile, over time, everything changed. Today, 4 types of anesthesia are used in medical practice. Each has advantages and disadvantages. How to choose the optimal one?

It is enough to read today's article, which tells about which anesthesia is better for caesarean section.

Nature provides that a woman should give birth in a natural way. Due to the fact that sometimes it was problematic to implement this, medicine offered a radical, but in some cases the safest option for delivery - caesarean section. Its essence lies in the fact that the doctor performs a surgical operation, due to which the fetus is removed through an incision in the uterus and peritoneum.

By the way, the procedure is rooted in antiquity. According to myths and legends, it was thanks to the Caesarean section that the world saw the god Apollo. It is worth noting that until the beginning of the 16th century, a caesarean section was performed only when the woman in labor was dying. But in 1500, a description appeared of the first case in Europe of the birth of a child through an operative intervention, as a result of which both mother and child remained alive.

For the first time, anesthesia began to be used in the middle of the 19th century. Its goal is to anesthetize as much as possible, allowing the woman to endure the upcoming operation well. The latter is performed within a few minutes, during which an incision is made in a certain place to remove the child. In the absence of complications, 5-6 days after the operation, the woman is discharged.

Absolute indications for its implementation are:

• discrepancy between the size of the fetus and the pelvis of a woman;
• clinically narrow pelvis;
• placenta previa;
• risk of uterine rupture during childbirth;
• fetal malformations.

Anesthesia is always used.

Anesthesia: types and contraindications

A pregnant woman who is about to have a caesarean section can choose from four types of anesthesia. This is about:

• epidural;
• spinal;
• general anesthesia;
• endotracheal anesthesia.

Each has pros and cons, and is also applied strictly according to indications. Local anesthesia for caesarean section is not done. Despite the refinement of the technique of performing the operation, there is always a minimal risk of exposure to the anesthetic on the child. Therefore, when making your choice in favor of one or another type, you should weigh all the pros and cons.

Epidural anesthesia

Epidural anesthesia, epidural, epidural anesthesia - as soon as young mothers do not call this type of anesthesia. Despite the variety of terms, its essence boils down to one thing: an injection is made in a certain place under the spine in the lumbar region. Thus, doctors gain access to the area where the nerves of the spinal cord pass and periodically inject an anesthetic drug into it through the catheter.

The main advantage of such anesthesia is in the clarity of consciousness. After the introduction of the drug, the patient does not fall asleep, but simply ceases to feel everything that is below her waist. She cannot move her legs, but she also does not feel any pain in the abdomen. Often, such anesthesia is given to young mothers during natural childbirth, so that they can follow all the doctor's instructions and painlessly give birth to the baby.

Its other benefits:

• the risk of irritation of the upper respiratory tract is eliminated, which is great news for women with bronchial asthma;
• the work of the cardiovascular system is not disturbed, due to the gradual gain in strength by the drug;
• the relative ability to move is preserved, which is extremely important in the presence of diseases of the muscular system;
• due to the presence of a catheter, the duration of the operation is adjusted (in other words, if necessary, doctors administer an additional dose of the drug);
• thanks to this injection, it is allowed to administer painkillers in the postoperative period - opioids.

The main indications for its implementation:

• premature birth at a period of less than 37 weeks;
• preeclampsia or high blood pressure, which is successfully knocked down thanks to the epidural;
• discoordination of labor due to the pronounced effects of oxytocin;
• prolonged childbirth that exhausts a woman, not allowing her to fully relax and recuperate.

There are also contraindications:

• failures in the process of blood clotting;
• diseases of an infectious nature;
• an allergic reaction to the drug used;
• transverse or oblique position of the fetus;
• discrepancy between the weight of the child and the pelvis of the mother;
• sometimes a scar on the uterus;
• the presence of pustules directly near the puncture site;
• spinal deformities.

Despite all the advantages described above, it is impossible to blindly agree to this anesthesia. Its disadvantages:

• Risk of intravascular or subarachnoid administration. In other words, the entry of anesthetic into the vessels or the arachnoid of the spinal cord, as a result of which a woman may develop convulsions, hypotension.
• The complexity of the procedure.
• The need to wait 15 - 20 minutes before the operation.
• Sometimes partial anesthesia, resulting in severe discomfort during surgery.
• The risk of penetration of the anesthetic through the placenta and respiratory depression, heart rate of the child.

The consequences of epidural anesthesia are also sometimes deplorable. These are back pains, and headaches, and problems with urination, and tremors in the legs. See the video for more on this.

spinal anesthesia

In general, this type of anesthesia practically does not differ from the previous one. As before, the woman is given an injection in the back, but this time the needle is inserted deeper, piercing the dense membrane that surrounds the spinal cord. That is why such anesthesia is called spinal anesthesia. The injection is placed strictly between 2 and 3 or 3 and 4 vertebrae to exclude the possibility of damage to the spinal cord. The needle is taken thinner, and the drug is administered less.

Spinal anesthesia has its advantages:

• complete anesthesia;
• fast action - the operation begins a few minutes after its introduction;
• minimal risk of developing consequences as a result of an accurate determination of the injection site;
• lack of toxic reactions in response to improper administration;
• comparatively cheap compared to other types of anesthesia.

Puncture Disadvantages:

• short duration of exposure to the body - only 2 hours;
• a small risk of a drop in blood pressure due to the rapid administration of the drug;
• the risk of headache in the frontotemporal lobe, which persists up to 3 days after the operation.

Spinal anesthesia is not done in the presence of contraindications, which are:

• rash at the puncture site;
• circulatory pathology, blood clotting disorders;
• sepsis;
• neurological diseases;
• spine diseases.

General anesthesia

It should be noted that at present, general anesthesia is used extremely rarely during caesarean section. This is explained by its detrimental effect on the health of mother and child.

The essence of the procedure is the introduction of an intravenous anesthetic, which acts within a few seconds. After that, a tube is inserted into the trachea, which is responsible for supplying oxygen. There are few indications for this type of anesthesia:

• bleeding, obesity, spinal surgery, bleeding disorders, due to which other types of anesthesia are not acceptable;
• incorrect position of the fetus or prolapse of the umbilical cord;
• emergency operation.

Advantages:

• fast pain relief;
• stable work of the cardiovascular system;
• simplicity and ease of procedure.

Disadvantages:

• the risk of aspiration, when stomach acid enters the lungs and causes pneumonia;
• the risk of depression of the central nervous system of the child;
• oxygen starvation of the woman in labor;
• risk of hypertension and increased heart rate.

How long do you recover from anesthesia? Doctors say that a few hours. Meanwhile, in fact, even after a few days, women can feel its detrimental effect on themselves, which is expressed in muscle pain, dizziness, nausea, cough, and injuries of the oral cavity.

Endotrachial

Endotrachial anesthesia involves the introduction of an intravenous drug, after which a tube is inserted into the trachea, providing artificial ventilation of the lungs. Through it, an anesthetic also enters the woman's body, which eliminates the risk of pain. It is used for urgent operations or a sudden deterioration in the condition of the mother and fetus.

Such anesthesia is contraindicated in bronchitis, pneumonia, tuberculosis, heart disease. It is also worth noting that it quickly anesthetizes. How long does endotracheal anesthesia last? It all depends on the time of the operation, since the drug can be additionally administered if necessary.

Its consequences:

Comparative table of different types of anesthesia

Finally, the table will help to figure out under which anesthesia it is better to do a caesarean section:

Which to choose

Only a doctor can choose the best anesthesia for surgical intervention based on anamnesis, because each procedure has its own advantages and disadvantages and affects both the condition of the woman in labor and the condition of the child. And these are not empty words, but reviews of women giving birth.

Therefore, do not neglect his advice. And also share the post on social networks and subscribe to updates. It was Lena Zhabinskaya, bye everyone!