When performing a caesarean section important is the choice of anesthesia technique. To do that properly, you need to understand about each of them, their advantages and disadvantages.
General anesthesia for cesarean section
This type of anesthesia is that on a pregnant woman by medication effects is loss of consciousness and sensitivity.
advantages of this General anaesthesia:
Tolerated easier woman, when properly used, gives an absolute pain.
Rapid effects of anesthesia. The operation can be started immediately, as this sometimes requires the threat status of the fetus.
Good conditions for cesarean section. Muscle woman completely relaxed, the mind is absent, these working conditions are good for the surgeon.
Stable state of the cardiovascular system. When applying this type of anesthesia, the pressure is not reduced, as it often happens before birth. For this reason, General anesthesia is a good choice for severe cardiac pathologies women, as well as the risks to the fetus.
This anesthesia is often practiced than epidurally or spinal anesthesia. Compared with these methods of anesthesia General anesthesia give high preference for many anesthesiologists.
Disadvantages of General anesthesia:
There is a risk that cannot be put in a plastic disposable trachea tube (intubation) and connect the mother to the ventilator.
Insufficient oxygen (hypoxia) can occur in women and to develop quickly due to the fact that reduced lung capacity, and the need for oxygen increases. This is due to the fact that in terms of the generic stress increases metabolism.
The risk of aspiration. This is when the lungs woman gets the contents of the stomach. This is due to the fact that respiratory protection is difficult or impossible at all.
If there is a need to connect to the system of artificial ventilation of the lungs can increase pressure and heart rate will increase.
The Central nervous system of the child is oppressed. Substances used in General anesthesia, cross the placenta, and act on the fetus and the development of a depressive state of his Central nervous system.
This is very important in cases when the pregnancy is premature or in the case where the period between the introduction of anaesthesia and between the genera too big. For example, women who are obese, those women who have already endured the caesarean section or other operations of the abdominal cavity. But doctors today are using such anesthetic drugs that are minimally depress the Central nervous system of the child. Picking the right drugs, General anesthesia has no serious consequences.
In any case shows General anesthesia?
the General anesthesia is shown in the following cases:
In such cases, when the fetus threatening or other cases requiring delivery.
In such cases, when regional anesthesia is contraindicated. This may be in cases of bleeding is a pregnant woman.
In cases where the woman refuses to regional anesthesia.
In cases where a pregnant woman is observed pathological obesity or had major surgery in the spine.
Epidural anesthesia during childbirth by cesarean section
Epidural and spinal anesthesia for cesarean seceretary type of anesthesia is that in the lumbar region of the back of the woman injected anesthetic into the epidural space between the vertebrae.
Benefits of epidural anesthesia:
The woman is conscious. Many mothers during cesarean sections want to keep in mind in order to observe the birth of their baby. Also the fact that the woman is conscious, eliminates the risk of aspiration or intubation.
Stable operation of the cardiovascular system. Pain begins gradually and this contributes to cardiovascular stability.
Retained the ability to move, though to some extent.
The airway is not susceptible to irritation. Patients with asthma should only choose this type of anesthesia, because he is the most gentle to the respiratory tract.
A longer duration. If the birth is complicated, use of epidural anesthesia operation can extend at any desired time.
Pain relief after surgery. For after the surgery, the woman did not feel the pain, into the epidural space of the injected opioids. This is a special narcotic analgesics (morphine, morphine).
Disadvantages of epidural anesthesia:
There is some danger of improper insertion of the anesthetic.
The introduction of a large dose of anesthetic can cause cramps and lower pressure. This is the result of toxic effects on the cardiovascular system and Central nervous system. In some cases, you may end up with brain damage or even death of the mother.
There is a risk of inadvertent injection of the drug under the arachnoid membrane of the spinal cord. If this time does not detect the introduction of a large dose of anesthetic in this area may affect the occurrence of total spinal block. Before you enter the anesthetic completely, enter test dose, you will need two minutes of observation in order to detect the occurrence of block. Conducting anesthesia, at hand must be a means for cardiopulmonary reinvigorate.
The technical difficulties. The technique of epidural anesthesia is a bit more complicated General, or spinal anesthesia. In contrast to spinal anesthesia, the frequency of epidural analgesia occurs more frequently when epidural anesthesia. The epidural space is only 5 mm. If you unintentionally hurt Dura, this can lead to postfunctional strong headaches. This happens in 2 % of cases with epidural anesthesia.
Increase the time interval between the beginning of the operation and the introduction of anesthesia. From the beginning of the introduction of anesthesia before an adequate blockade will need 15-20 minutes. Epidural anesthesia compared with spinal or General, can not be used when time is limited.
High probability of inadequate anesthesia. In 18% of cases with epidural anesthesia introduction of an anesthetic drug in the lumbar region may block the sacral nerves. This happens mainly with the introduction of high doses of anesthetic during surgery on the organs of the pelvis leads to discomfort.
The neurological complications. If women had neurological complications, such as damage to the bundle of spinal nerves, called a pony tail, then they should be excluded. When epidural anesthesia is the isolation of the nerve root. This can lead to injury catheter or needle.
Epidural anesthesia is shown in the following cases: in the case when the establishment of the catheter has already occurred, for example, when women undergo childbirth, and epidural anesthesia have been used as effective and safe. Also at high obstetric risk, when there is the risk of changes in blood pressure.
Spinal anesthesia for cesarean section
Spinal anaesthesia is called spinal. Its meaning is that the woman is injected anesthetic into the lumbar region of the back in podavlennoe space between the vertebrae. Spinal anesthesia involves piercing the dense membrane that surrounds the spinal cord. In the use of epidural anesthesia DRS enter a little deeper than spinal anesthesia.
Anesthesia for cesarean section
the advantages of spinal anesthesia:
Very good analgesic effect;
Quick start operation. The interval between the introduction of anesthesia and start of operation is approximately two minutes;
Easy way of doing it. In contrast to General and epidural anesthesia, spinal anesthesia is a little easier to implement, because it can accurately determine the final injection needles.
No systemic toxicity occurs.
If the anesthetic mistakenly injected vnutricostna, CNS or cardiovascular system, you do not experience toxic reactions. Therefore, the use of spinal anesthesia in this respect is more dangerous than an epidural.
Disadvantages of spinal anesthesia:
The duration of action is limited. When spinal introduction once the siege is limited by the properties of the anesthetic drug. The anesthetic effect on average two hours.
The anesthetic begins to act very rapidly, it causes sharp decrease in blood pressure.
Postfunctional headaches. The frequency of its occurrence can be from 3% to 24%. It depends on the experience of specialists, as well as on the popularity of this method. If the headache lasts from one to three days, it is not a cause for concern. Important is the strong expression postponing headache. It can last for many months and to influence the decreasing disability.
Neurological complications. Single administration of anesthesia to use only sterile instruments, purified of local anesthetics and ancillary drugs, a good needle. This is necessary to prevent complications such as chemical or bacterial meningitis. When conducting extended spinal anesthesia may be damaged pony tail.
This can happen for the same reasons: it may be incorrectly located the catheter, so in such cases it is necessary to apply additional doses of anesthetic, and it may cause long-term blockade of the lumbar and sacral nerves. If the catheter has intraspinal position, it can lead to injuries of the spinal cord due to its rupture or stretching the object of an administered drug. So, to avoid this from happening, you need to remember that if the dose of anesthetic was small, no need to do more injections, catheter in this case, re-enter or use another method of anesthesia.
In the use of spinal anesthesia has many advantages. It is the most appropriate for caesarean section. General anesthesia is used when the fetus is developed hypoxia or there are contraindications to regional anesthesia. This may be the case dramatic expression pathology, antenatal hemorrhage, increased pressure inside the skull. Contraindications to the use of spinal anesthesia is premature detachment of the placenta. Epidural anesthesia is used in cases when it was used enough epidural blockade.