Of course, childbirth is a difficult and painful process. Anesthesia can reduce pain. In this article we will look at the types of anesthesia used for caesarean section, but it should be remembered that the choice always remains with the specialist.
General anesthesia
General anesthesia for caesarean section is performed if there are contraindications to regional techniques, as well as in cases where the woman or the operating surgeon does not want to maintain consciousness during the intervention.
With this type of anesthesia, the woman completely loses sensitivity and consciousness, complete pain relief is provided and, most importantly, the anesthesia is quite easily tolerated by the mother. General anesthesia is possible when immediate surgery is needed; induction of anesthesia occurs quickly and allows you to avoid consequences in cases of threat to the fetus. Also, among the advantages, it should be noted that complete muscle relaxation and absence of consciousness in the woman in labor provide good conditions for the work of a surgeon.
General anesthesia does not affect cardiac stability vascular system. Compared to spinal and epidural anesthesia, there is usually no reduction in pressure prior to the moment of birth, so general anesthesia is the method of choice for performing caesarean section against the background of threatened conditions of the fetus and severe cardiac pathology of the mother.
An easier and more commonly used technique in operating rooms than spinal or epidural anesthesia. Compared to spinal or epidural (together both methods are called regional anesthesia in the text) anesthesia, general anesthesia give preference larger number anesthesiologists.
General anesthesia is indicated:
- In cases where rapid delivery is necessary, for example, in case of threatening conditions of the fetus.
- In cases where regional anesthesia is contraindicated, for example due to bleeding.
- In cases where regional anesthesia is not possible due to morbid obesity or major spinal surgery.
- In cases where a woman in labor refuses regional anesthesia.
Flaws:
1) The risk of inability to perform tracheal intubation (place a disposable plastic tube in the trachea and connect the woman in labor to the device artificial respiration) for different reasons.
Hypoxia (lack of oxygen) in women in labor increases faster due to reduced lung capacity and higher oxygen demand associated with increased metabolism under conditions of labor stress.
2) The risk of aspiration (stomach contents entering the lungs) is usually associated with the difficulty or impossibility of prompt protection respiratory tract.
3) Increased pressure and increased heart rate in response to an attempt to connect to the system artificial ventilation lungs.
4) Depression of the central nervous system of the newborn. General anesthetics in varying degrees penetrate the placental barrier, which is fraught with the development of depression of the central nervous system of the fetus and newborn. This is of particular importance in cases of prematurity or in situations where the time interval between induction of anesthesia and delivery is prolonged (for example, in patients with severe obesity or in cases of previous cesarean sections or other abdominal operations, when the development of abdominal adhesions can be expected).
However, thanks to the use of modern anesthetic drugs in obstetrics, depression of the newborn's central nervous system has become minimal and short-lived; with the correct selection of drugs, it does not have serious consequences and should not be a deterrent to the use of general anesthesia.
Epidural anesthesia
The idea of regional (acting within only a limited part of the body) nerve block in general, and epidural block in particular, is not new. The only novelty is how widely it began to be used in obstetrics. Painkiller through thin catheter tube, administered through a special needle (after numbing the skin of the back with a local anesthetic), enters the space between the spinal cord and its outer membrane.
After 1980, demand for the procedure soared so rapidly that most anesthesiologists had to learn how to use it during childbirth. Thus, the popularity of epidural anesthesia in obstetric care led to the emergence of a new medical subspecialty - obstetric anesthesiology. The daily use of epidural anesthesia during childbirth has revealed new circumstances. Increasingly, cases arose when the decision to resort to a caesarean section was made already during the effect of epidural anesthesia. And then the advantages of local anesthesia over general anesthesia became obvious, because my mother remained conscious during the operation and immediately after it.
Flaws:
1) Risk of erroneous intravascular administration
Intravascular administration of a large dose not detected in a timely manner local anesthetic can lead to the development of seizures and a sharp decrease in pressure due to a toxic effect on the central nervous system and cardiovascular system. This complication may result in maternal death or brain damage.
2) The danger of unintentional subarachnoid injection (administration of an anesthetic drug under arachnoid membrane spinal cord)
As a result of undetected subarachnoid injection of a large dose of local anesthetic intended for epidural block, total spinal block may develop. If at the same time therapeutic measures delayed, respiratory arrest and sudden hypotension occur, which lead to cessation of cardiac activity. Therefore, in each case, a test dose should be administered before using the main dose of local anesthetic. Waiting 2 minutes is enough to determine the possible occurrence of a subarachnoid block. In any case of administration of a local anesthetic, including epidural anesthesia, it is necessary to have appropriate means for cardiopulmonary resuscitation on hand.
3) Technical difficulties
The epidural technique, compared to general or spinal anesthesia, is more complex. It depends on tactile sensitivity (roughly speaking, golden hands or growing not quite from where they should be). Identification of the epidural space is not as clear as with spinal anesthesia when the appearance of cerebrospinal fluid indicates the correct placement of the needle tip. In this regard, the failure rate with epidural blocks is higher than with spinal anesthesia. The lumen of the epidural space is only 5 mm. Unintentional dural puncture, which occurs in 2% of cases, can lead to severe post-puncture headaches.
4) Lengthening the time between the introduction of anesthesia and the start of the operation. It takes 10-20 minutes from the moment of induction of anesthesia (injection of local anesthetic) until the start of an adequate blockade. Thus, compared to general or spinal anesthesia, the epidural technique cannot be used when the time period is limited.
Spinal anesthesia
With spinal anesthesia, the nerve is blocked at the part of it that exits the substance of the spinal cord, but is still washed by the cerebrospinal fluid. It is into this liquid that the blocking agent is injected. As a result, one injection provides a blockade of many nerves. Spinal anesthesia causes more deep relaxation abdominal muscles than any of the available inhalational anesthetics. A small dose of the drugs needed for spinal anesthesia reduces their toxicity, but this method is still fraught with serious complications.
Spinal anesthesia is very similar to an epidural in that fluid is first given intravenously and then a needle is used to inject local anesthetic into the space surrounding the spinal cord. The difference is that with spinal anesthesia, a much smaller needle is used and the dura mater (which is around the spinal cord) is specifically pierced, after which the local anesthetic is injected directly into the cerebrospinal fluid.
Spinal anesthesia is very effective in controlling the pain of caesarean section and forceps placement, often much better than epidural anesthesia.
Considering the advantages mentioned above, we believe that spinal anesthesia is the best technology for caesarean section. Correct assessment of the shortcomings of the method, prevention of complications, and in cases of their development - adequate and timely treatment are important additions to the statement made.
Contraindications to spinal anesthesia:
- Hypovolemia (blood loss, dehydration, etc.)
- Coagulopathy (blood clotting disorder).
- Treatment with anticoagulants.
- Sepsis
- Bacteremia
- Skin infection at the puncture site.
- Increased intracranial pressure.
- Allergic reaction to local anesthetics.
- Bradycardia, heart rhythm disturbances.
- Distress, fetal hypoxia.
- Exacerbation of herpetic infection.
- Diseases of the Central Nervous System
Flaws:
1) Limited duration of action. With a single spinal injection, the duration of the blockade is limited by the properties of the anesthetic (adequate pain relief for 2 hours, i.e., an interval that usually covers the time requirements for cesarean section).
2) Abrupt start actions and a pronounced degree of reduction in blood pressure. This disadvantage can be mitigated with the help of preventive measures.
3) Postpuncture headache. The incidence of post-puncture headache varies across different medical institutions from 2% to 24% depending on the popularity of the method and the experience of employees. Low or moderate degree the severity of the headache (lasting 1-3 days) is not significant. Only severe post-puncture headache is important because it lasts for many days and months and leads to disability.
4) Neurological complications
a) For anesthesia with a single injection
The use of sterile instruments, highly purified local anesthetics and auxiliary drugs, and good needles ensures the prevention of such serious complications as bacterial or chemical meningitis.
b) With prolonged spinal anesthesia
Damage to the cauda equina has been described as a dangerous neurological complication of this technique. His reasons are explained:
- Incorrect placement of the catheter, resulting in the need for excessive doses of concentrated local anesthetic solution, which can ultimately lead to long-term residual blockade of the lower lumbar and sacral nerves.
- Intraspinal position of the catheter, which is fraught with direct trauma to the spinal cord due to its stretching or rupture by the injected volume of the drug. To prevent such a formidable complication, it should be remembered that if the calculated total dose of local anesthetic was insufficient to cause the expected block, subsequent injections should be abandoned, the catheter should be reinserted, or the technique of simultaneous spinal anesthesia or another form of anesthesia should be preferred.
If during pregnancy the mother has indications for surgical delivery, then she is scheduled for a planned operation. It involves removing the newborn from an incision in the abdomen and uterus. Like any abdominal operation, cesarean requires mandatory anesthesia. Patients are often given a choice of the type of anesthesia, and many of them choose an epidural. Epidural anesthesia for caesarean section has specific features, advantages and disadvantages, which must be taken into account when choosing pain relief.
There are several common anesthesia options that are widely used for caesarean sections. These include:
- General anesthesia. With such anesthesia, the woman is in unconscious, she is immersed in a medicated sleep, in which there is no understanding of what is happening and no sensitivity. During endotracheal general anesthesia, a special tube is inserted into the trachea, which communicates with a device that provides pulmonary ventilation. This anesthesia begins to work almost instantly, so it is used when urgent care is needed. surgical intervention.
- Spinal anesthesia belongs to the methods of regional anesthesia, which are safer for the baby and the woman in labor. Such anesthesia involves the introduction of a special anesthetic drug through a very thin needle into the cerebral fluid of the spinal canal. The procedure is practically painless and does not cause much discomfort, except for a slight feeling of pressure. To administer the anesthetic, the woman should lie on her side with her knees pressed to her stomach. As a result, the mother does not experience any painful sensations during the delivery process, she remains conscious throughout the operation, and after the baby is removed, she will be able to see him immediately.
- Epidural anesthesia, like spinal anesthesia, is a regional type of anesthesia. According to the mechanism of action and conduction, it is close to the spinal one, although it has several differences.
Each technique is good in its own way, but there are also contraindications. More often than other types, epidural anesthesia is used for caesarean section.
Epidural pain relief
Anesthesia using this method is usually used for planned delivery operations, because it begins to act gradually, 20 minutes after the puncture. Such anesthesia does not require such high professionalism and precision as spinal anesthesia, since the drug is injected into the epidural spinal cavity. A needle is inserted between the spinal dura mater and the wall of the brain canal, through which a catheter passes. The needle is then removed, and an additional dose of anesthetic can be administered through the remaining catheter if necessary.
Epidural anesthesia is often used during traditional childbirth to eliminate painful sensations and facilitate the process of natural childbirth in women with an overly heightened perception of pain. After administering the drug, the nerve roots begin to lose sensitivity, as a result, the woman soon ceases to feel the lower half of the body. Moreover, all types of sensitivity disappear: pain, thermal, tactile, etc. At the same time, the woman in labor is in a clear consciousness and can contact doctors. After a cesarean section, such anesthesia lasts for several more hours.
If the technique of administering the anesthetic was violated during the epidura, then pain relief may only spread to half of the body. If epidural anesthesia cannot be performed for some reason, then a cesarean section is performed under general anesthesia.
How is pain relief performed?
When a woman decides on the choice of anesthesia, her preparation begins, which includes psychological work, identifying possible allergic reactions, taking sedatives and so on. The patient must be examined: blood pressure, temperature and other health indicators are measured. Woman renting lab tests to determine rhesus, blood group, hemoglobin and red blood cells, leukocyte and platelet counts. A coagulogram is required to determine the concentration of prothrombin and fibrinogen.
After all the above procedures, if epidural anesthesia is approved, they proceed directly to the operation, which begins with the work of the anesthesiologist. A catheter is inserted into a peripheral vein, an infusion system is connected, a cuff is placed to control blood pressure, and an oxygen mask is prepared. The woman is placed on her side and anesthesia is injected between the lumbar vertebrae, most often lidocaine is used.
Throughout the operation, the patient is closely monitored, including monitoring respiratory functions and hemodynamic parameters such as pulse, heartbeat and blood pressure. Typically, the effect of the epidura lasts for several hours after surgery.
The benefits of an epidural
Doctors can perform such anesthesia for caesarean section in two ways: with or without a catheter. When inserting a catheter, a small dose of anesthetic is initially injected, and then an additional dose is given if necessary. If a catheter is not installed, then the drug is immediately administered in a large dose so that its effect is sufficient for the entire operation.
The use of an epidural during surgical delivery has some advantages, for example, the absence of side effects oxygen starvation the fetus and the woman in labor, which is observed during general anesthesia against the background of repeated insertion of a tracheal tube or due to an incorrectly configured pulmonary ventilation device. There are other advantages of such pain relief:
- During the entire cesarean procedure, the patient remains fully conscious and understands what is happening around her, so it remains possible to hear and see the baby immediately after its removal;
- Absent irritant associated with airway damage during intubation;
- During the operation, relatively stable cardiovascular functioning is ensured;
- The anesthetic drugs used are not capable of causing toxic harm to the fetus;
- Epidura provides a fairly long-lasting analgesic effect, so it is successfully used during natural childbirth, caesarean sections, etc.;
- It is possible to use anesthesia on a non-empty stomach, whereas general anesthesia requires abstinence from food.
Epidural pain relief is very effective against post-operative pain syndrome, when appropriate drugs are administered through a catheter after the intervention, therefore such anesthesia is widely used in surgical practice.
When is such anesthesia indicated?
In order for a caesarean section to be performed with epidural anesthesia, a number of relevant indications are taken into account. Such anesthesia is recommended if a woman in labor has pathological abnormalities like diabetes mellitus or gestosis, heart defects or hypertension, for various kidney diseases. In addition, an “epidural” is performed in a situation where, at the beginning of natural childbirth, a similar anesthesia was already used for pain relief, but complications arose and the patient urgently needs to undergo a delivery operation.
Similar anesthesia is also indicated for premature pregnancy, if the pregnant woman has liver disorders, with cervical pathologies or excessive uterine activity. If contraindicated general type anesthesia, then the woman in labor also undergoes a cesarean section with epidural anesthesia.
Epidure, in comparison with general anesthesia, is a more gentle and safe procedure for the child, but when choosing anesthesia, the specialist always evaluates general state mother and fetus.
Disadvantages of epidural anesthesia
Although there are many advantages, epidural anesthesia for caesarean section also has some disadvantages. Such injections help reduce blood pressure, which in some situations can provoke a pronounced nausea attack and severe dizziness during the operation. If the technique for administering the anesthetic is not followed, convulsive attacks and a rapid decrease in pressure may occur, which can lead to serious brain damage and even death.
The influence of drugs on the fetus cannot be ruled out, although it does not enter the child’s body directly; it can negatively affect it through complications on the mother’s body. If for some reason the delivery operation lasts for more than two hours, then the epidural will have to be extended, that is, increased doses of anesthetic medication will have to be administered. It can also negatively affect the newborn.
Contraindications to this type of anesthesia
To avoid possible negative consequences, it is necessary to take into account some requirements for this type of anesthesia. Of course, doctors will not give such pain relief to a woman if she herself refuses it. In addition, it is impossible to provide complete epidural pain relief in the absence of the necessary equipment, materials, and specialization of the anesthesiologist. Also contraindications include:
Therefore, when choosing such anesthesia, you should definitely take these contraindications into account. Otherwise, there is a high risk of developing undesirable consequences that are dangerous for the fetus and mother.
Possible adverse reactions and negative consequences
Typically, epidural anesthesia rarely causes any complications, but if the anesthesia technique is not followed, the patient may face similar consequences. The feeling of numbness, goosebumps and tingling in the limbs, which occurs in the first minutes after the administration of the medication, is considered quite natural. This is a normal reaction indicating the onset of action of the anesthetic drug. Such sensations will disappear after the therapeutic effect of the medication ceases. Spontaneous trembling, which subsequently goes away on its own, is also considered a normal reaction to management.
If the sterility at the puncture site is compromised, inflammatory processes, for the elimination of which the use of local antibiotics in the form of solutions or ointments is indicated. If during the operation a woman’s blood pressure drops sharply, then the consequences of epidural anesthesia are possible in the form of a nausea-vomiting reaction, which is eliminated by normalizing blood pressure. For this, cardiotonic drugs like Metasone or Epinephrine are prepared in advance.
Sometimes, with insufficient preoperative preparation, a woman in labor may experience a sudden allergic reaction to the anesthetic. Then it is necessary to stop its administration and stop the attack with antiallergic drugs such as Dexamethasone or Suprastin. If during the insertion process the anesthesiologist mistakenly pierced a hard bone meninges, then the woman in labor will subsequently experience pronounced headaches. In such a situation, daily bed rest is necessary; you are allowed to get up only the next day. This purpose is caused by an increase in pressure in the spinal canal in vertical position, as a result of which fluid leaks out, leading to headaches. In addition to bed rest, taking painkillers like Analgin, etc. is recommended.
It happens that women complain of pain in the back, the causes of which are associated with traumatic damage to the spinal nerve root during the puncture process. If an anesthetic is introduced into a vessel by mistake, acute systemic intoxication may develop. To avoid this, an aspiration check is performed or a test dose is applied. According to statistics, adverse reactions or complications arise when contraindications to the use of such anesthesia are not observed.
There is no anesthesia that does not have any contraindications. If a caesarean section is planned in advance, then the type of anesthesia is selected taking into account the wishes of the woman in labor, but contraindications and indications are also necessarily taken into account. There are specific criteria by which the most optimal pain relief is determined.
- The general condition of the woman in labor and the presence of certain pathologies in the anamnesis. If the patient has reduced blood clotting or has pathologies such as lumbar osteochondrosis, then spinal and epidural anesthesia is unacceptable. If the pregnant woman has a family history of hyperthermia of a malignant nature, then it is contraindicated. general anesthesia.
- Planned duration of the procedure. If additional surgical procedures are planned during a caesarean section, then a general type of anesthesia is prescribed; for uncomplicated delivery operations, the choice remains with regional anesthesia. Epidural anesthesia provides a longer anesthetic effect than spinal anesthesia, but is less profound. With any regional anesthesia, a decrease in pressure is noted, which, with a long-term effect, can lead to fetal hypoxia.
- Consideration of indications for delivery surgery. In case of emergency intervention, the choice falls on general anesthesia, because it acts instantly. A planned cesarean section allows the use of local types of anesthesia, in which the woman will be conscious, so she will be able to see the baby immediately after extraction and hear his first cries.
Local anesthesia methods are less dangerous for the patient and baby, but the final choice is determined together with the doctor based on the specific case.
What do the doctor's say
Doctors insist that epidural pain relief is permissible only for appropriate indications. Today, many patients, because of the fear before childbirth, literally demand such anesthesia for natural, uncomplicated childbirth. Typically, women in labor begin to require pain relief when labor is almost over. And at this time, pain relief is categorically unacceptable, since anesthesia will negatively affect contractions, and the woman in labor will not be able to push the baby out on her own.
Epidural anesthesia is more of a surgical intervention into the spinal structures, rather than a harmless pain-relieving injection. Even with today's safe, reliable and advanced medical technologies the possibility of complications cannot be excluded. Therefore, during a caesarean section, epidural anesthesia is the optimal method of pain relief, but during natural childbirth it is better to refuse it.
If during pregnancy there are contraindications to natural childbirth, an operation called a caesarean section is performed. The baby is removed from the uterine cavity through a hole made in the peritoneum. Like other types of abdominal surgery, the procedure requires pain relief. An epidural or caesarean section has both positive and negative features that need to be taken into account. They differ in the principle of action and possible side reactions of the body. What is best is decided by the doctor in each individual case. Epidurals, compared to spinal anesthesia, are in great demand.
How epidural anesthesia works
Epidural anesthesia for caesarean section is carried out as planned. Sometimes it is urgently used during traditional labor activity. This type of pain relief helps to reduce the susceptibility of nerve receptors, which provokes a complete loss of sensation in the lower extremities.
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During a caesarean section, the analgesic effect lasts for several hours. If a woman has contraindications to this type of anesthesia, general anesthesia is performed.
Once the needle enters the epidural area, the meninges are pulled back. The anesthetic substance is introduced gradually, starting with a dosage of 5 ml. The drug blocks the transmission of pain impulses located in the spinal cord. As a result of this, pain disappears. The area below the waist is completely numb.
The difference between epidural anesthesia and spinal anesthesia
Many people mistake epidural anesthesia for spinal anesthesia. There is a big difference between these types of pain relief. The main difference is the speed of onset of the effect. When performing spinal anesthesia, the lower area of the body becomes numb no later than 10 minutes after the injection. It is not individual sections of the spinal cord that are blocked, but its entire area.
Epidural and spinal anesthesia
Drugs used
Anesthetics used for elective surgery by delivery, are classified according to the principle of impact on the body and the duration of the effect. Supplementing such drugs with Epinephrine can increase anesthesia for several hours. Before administering drugs, you must ensure that there is no allergic reaction.
The most common drugs with an analgesic effect include:
- Bupivacaine . Belongs to the category of aminoamides. During surgery, it is used in a concentration of 0.125 to 0.25%.
- Ropivacaine . It differs from the previous anesthetic in reduced effectiveness. When conducting surgical operation used in dosages of 0.5, 0.75 and 1%.
- Lidocaine . The action is based on the aminoamide content. When performing epidural anesthesia, a dosage of 2 or 1.5% is administered. Without combining with other drugs, Lidocaine provides pain relief lasting from 60 to 100 minutes. When combined with other anesthetics, its effect is prolonged by 50%.
- Chloroprocaine . During surgery, they are used in a concentration of 30%.
How is the anesthetic administered?
The procedure for administering the anesthetic is carried out while in a sitting or reclining position. According to the principle of implementation, it resembles a puncture. The difference is that no biomaterial is collected. The area where the needle is inserted is pre-treated with an antiseptic. The injection is given into cerebrospinal fluid located in the spine area. A needle is used for this; its length is 9 mm and its diameter is 2 mm. Then a catheter is attached to the needle, through which the medicine is delivered. After completing the infusion of the solution, the catheter is removed and the needle is left in place. This is necessary so that medicine can be added during basic manipulations.
Administration of anesthetic The required effect after pain relief is achieved within 20 minutes. There is a loss tactile, tactile and pain sensitivity. The woman is fully conscious. This is necessary to be able to contact medical personnel.
Contraindications
Before using epidural anesthesia, you should familiarize yourself with the list of contraindications. Their presence is determined in advance, as part of a preventive examination of the body.
A woman in labor should refuse this type of anesthesia in the following cases:
- oxygen starvation of the fetus;
- diseases of the central nervous system;
- heavy bleeding;
- lack of tools and equipment for the procedure;
- individual intolerance to anesthetic;
- blood clotting abnormalities (or taking medications that affect blood viscosity the day before);
- infectious diseases in acute form.
If you do not take into account a woman’s tendency to bleed, there is a risk of significant blood loss. When the fetus is deprived of oxygen, anesthesia aggravates the current situation, provoking various complications, including the death of brain cells. In case of an allergic reaction, there is a risk of developing Quincke's edema. It is accompanied by rapid swelling that blocks the airways. The danger of this phenomenon lies in increased risk fatal outcome.
pros
Epidural anesthesia is in demand due to a number of advantages over other types of pain relief. These include the following:
- At the moment the child is born, the woman is conscious. This helps doctors monitor her condition during the caesarean section.
- The epidural has a long-lasting effect. The woman does not feel the lower part of the body from 1 to 4 hours.
- There is no irritation of the respiratory organs, which occurs during inhalation anesthesia.
- If anesthesia is used during natural labor, a woman can save strength during the most painful contractions. This has a positive effect on the outcome of childbirth.
- The process of recovery from the state of anesthesia is quite fast. Within a day after the operation, the woman can perform physical activity.
- It is allowed to carry out the anesthesia procedure on a full stomach. Under general anesthesia, patients are prohibited from eating on the day of surgery.
- The drugs used during anesthesia do not have a toxic effect on the fetus.
- Due to the fact that doctors perform epidural anesthesia in doses, there is no effect on the functioning of of cardio-vascular system.
Despite the abundance of positive features, the anesthesia procedure is not safe. The disadvantages of the method include the possibility of errors during execution. The drug should only be administered by a qualified specialist.
Flaws
Women who are about to have a cesarean section are primarily interested in whether the injection hurts. There is no clear answer to this question. It all depends on the degree of height of the pain threshold of the woman in labor. According to reviews, the pain from contractions outweighs the intensity of the discomfort that appears at the moment the needle is inserted.
Besides discomfort, the following disadvantages of the procedure are highlighted:
- This type of pain relief can cause an increase in blood pressure, which causes nausea and dizziness.
- If the medication administration technique is violated, there is a risk of developing seizures and damage to brain cells as a result of a sharp rise in pressure.
- It is impossible to calculate in advance how long the operation will take. If the effect of the anesthetic wears off before the baby is born, the woman will have to be urgently transferred to general anesthesia. This comes with certain risks.
- After epidural anesthesia, there is a possibility of neurological disorders. In most cases they appear. This is due to cerebrospinal fluid getting into an area where it shouldn't be.
- Having a caesarean section under epidural anesthesia causes psychological discomfort in most women. The operation can leave an imprint on the mental state, provoking the development of various disorders.
In rare cases, incomplete pain relief occurs, which causes discomfort both for the woman in labor and for doctors. There is also the possibility of neurological abnormalities, which include paralysis of the limbs and other undesirable complications. This is possible in case of accidental injury to a nerve root. A qualified anesthesiologist will not encounter such problems. Therefore, attention should be paid Special attention choice of doctor.
Risks
Spinal or epidural anesthesia carries risks. If not complied with sanitary standards, there is a possibility of inflammation developing as a result of infection. This threatens health complications. The use of anesthesia may be accompanied by nausea, spontaneous tremors, dizziness and loss of consciousness. These side effects can affect the course of the operation. No one is immune from developing an allergic reaction. Therefore, it is extremely important that the injection process is carried out in accordance with established standards.
It is impossible to predict in advance how the body will react to the introduction of an anesthetic. There have been cases when numbness was noted only on one side of the body. In some cases, women felt discomfort during the operation. There is also a risk of losing consciousness during the procedure due to excessive anxiety.
Complications after epidural anesthesia
Epidural anesthesia given before cesarean section leads to various undesirable consequences. A new mother does not encounter them immediately, but after some time. The likelihood of their development increases if childbirth is accompanied by complications.
Immediately after emerging from anesthesia, a woman’s consciousness may be slightly clouded. In the first hours after surgery, there is muscle weakness and decreased tactile sensitivity. In some cases, there are difficulties with urination.
The most common complications include pain in the back or head. This happens when the injection technique is violated or due to accidental contact with nerve receptors. Problems with the respiratory system may also occur. They arise as a result of contact medicinal substance under the arachnoid surface of the spinal cord.
Anesthesia is dangerous not only for the woman, but also for her child. Due to the fact that the process of childbirth is unnatural, the baby’s adaptation to the world around him slows down. As a result of the administration of the anesthetic, the child is born insufficiently active. The risk of formation increases hypoxia, which provokes various developmental deviations. It is noteworthy that Apgar scores can be quite high. The consequences of anesthesia become known as the child grows older.
Price
In every medical institution certain prices for the service are set. The final cost depends on the dosage of the administered drug. On average, the anesthesia procedure costs 3,000-5,000 rubles. If indicated, childbirth can be anesthetized free of charge, according to insurance policy. If a woman expresses a desire for anesthesia in the absence of compelling reasons, she must pay for the service in full.
Doctors' opinion
Doctors say that epidural anesthesia for caesarean section is a necessary component. Before using it, it is extremely important to weigh the risks and exclude the presence of contraindications. This will avoid unintended consequences. There is no clear answer to the question “which anesthesia is better for caesarean section”. The choice of anesthesia is made on an individual basis.
General anesthesia for caesarean section is performed in the following cases:
- the woman is obese;
- atypical position of the fetus in the womb;
- diagnosing oxygen deficiency in a child;
- the presence of one or more contraindications to other types of anesthesia;
- spontaneous deterioration of the patient's condition during a surgical procedure.
When choosing anesthesia, the woman’s health condition is taken into account. Her preferences are the last thing to be paid attention to. If a woman has nervous disorders, her response to an epidural can be unpredictable. Excessive emotionality during surgery can interfere with doctors. In this case the best option There will be general anesthesia.
For a child, epidural anesthesia is more preferable. Immediately after his birth, contact is established with his mother, who is conscious. This has a positive effect on milk production and the baby’s speed of adaptation to new conditions.
During natural delivery, it is recommended to use anesthesia only if indicated. If childbirth is not complicated, there is no need for anesthesia. Anesthesia can negatively affect contractions, which will prevent the woman in labor from pushing the baby out.
Conclusion
The choice of method of pain relief for caesarean section is made by the doctor. Epidural anesthesia has many advantages. But before doing it, you should study the disadvantages. Spinal anesthesia is used even less frequently than epidural. This is due to the complexity of implementation and the principle of impact on the human body.
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C-section(CS) is one of the most common operations in obstetric practice, used in complicated pregnancy and childbirth, allowing to preserve the health and life of the mother and child. Like any surgical intervention, CS surgery requires pain relief. The two most common methods are general anesthesia and epidural anesthesia. What determines the choice of anesthesia? What are the advantages and disadvantages of each? Let's figure it out.
Epidural anesthesia
Epidural anesthesia is a type of regional anesthesia that allows you to eliminate pain in a specific part of the body. In our case - at - in the lower half of the body.
Methodology
Preparation begins 30-40 minutes before surgery. A sterile needle is used to puncture the skin at the lumbar level and through intervertebral discs the needle enters the epidural space. The anesthesiologist then inserts a soft, thin plastic tube (catheter) through which the medicine (painkiller) will flow, and removes the needle.
information When medicinal product begins to act, the woman ceases to feel the lower part of the body: pain, temperature and tactile sensitivity disappears, approximately from chest level to the tips of the toes. At the same time, expectant mother clear consciousness remains: she hears, sees everything and can control her condition herself.
Advantages
- The woman remains conscious and is able to independently control her well-being, which allows her, if any discomfort occurs, to inform the anesthesiologist about it so that he can take measures to eliminate it;
- The relative stability of the maternal cardiovascular system is maintained, which allows avoiding additional administration of other medications;
- The woman in labor breathes on her own, there is no need to intubate the trachea, which means that trauma and irritation of the upper respiratory tract are eliminated;
- If it is necessary to prolong the operation, an additional dose of the drug can be administered through the left catheter, which will allow it to be extended for the required time, and after the operation it can be added narcotic analgesics to facilitate the postoperative period;
- The overall harm to the child from epidural anesthesia is not great due to the lack of many drugs used in general anesthesia. However, depending on what medicines were used (only anesthetics or also narcotic drugs), some complications are possible: a decrease in the child’s heart rate, hypoxia, respiratory failure. With a competent approach from a pediatric neonatologist, all these complications can be easily eliminated.
Flaws
- Carrying out epidural anesthesia requires a highly qualified doctor, since the lumen of the epidural space is only 5 mm, there is a high probability of affecting the dura mater, which can subsequently lead to severe headaches (2% of cases);
- At least 20 minutes must pass from the time of administration of the drug to the start of the operation, which makes it difficult to use this method in emergency cases;
- Sometimes the catheter may be placed unevenly, which can lead to one-sided pain relief and discomfort during surgical procedures. Therefore, before starting the operation, be sure to check sensitivity on both sides and only then proceed with the operation;
- In view of individual characteristics In the body, isolated damage to the nerve root by a needle or catheter is possible, followed by the occurrence of neurological complications (headaches, which in rare cases can last for several months).
General anesthesia
In most cases, this method of pain relief is used in emergency situations or when epidural anesthesia is not possible (there are contraindications or there is no proper technical support). The woman is unconscious throughout the operation and does not feel anything.
Methodology
General anesthesia for caesarean section is carried out in three stages. First, the woman is given a “preliminary anesthesia” intravenously, allowing her to fall asleep, then the trachea is intubated. To the bottom windpipe a tube is inserted through which oxygen and anesthetic gas will subsequently flow. The third stage is the introduction of muscle relaxants, which relax all the muscles of the body, including the uterus. After this, the operation begins.
Advantages
- It does not take much time to induce anesthesia;
- Easier and most commonly practiced technique;
- There are practically no contraindications for use;
- Creates excellent working conditions for surgeons and anesthesiologists;
- The condition of the woman’s cardiovascular system during the operation is more stable.
Flaws
- There is a risk of lung aspiration from gastric contents;
- There may be difficulties with tracheal intubation, its traumatization and, as a result, the occurrence of sore throat, cough, respiratory tract infection, and pneumonia in the postoperative period;
- The large number of drugs administered during general anesthesia can have a negative effect on the mother and affect the baby;
- Anesthetics and narcotic substances used during anesthesia have a depressing effect on nervous system child, expressed in lethargy, lethargy and drowsiness. May also cause breathing problems in the newborn, which may require resuscitation measures by a neonatologist.
Which anesthesia should I choose?
At the stage of preparation for a planned caesarean section, in most cases the choice between general anesthesia and epidural anesthesia remains with the expectant mother. However, here it is necessary to take into account the equipment of the maternity hospital and the qualifications of specialists.
important In addition, if there are contraindications to epidural anesthesia (acute infectious diseases, injuries and diseases of the spine, bleeding disorders, oblique or transverse position of the fetus), no matter how much you would like to be present at the moment the baby is born, for the sake of your safety they will not be able to allow you to do so .
Let's summarize and compare these two types of anesthesia.
| Epidural anesthesia | General anesthesia |
| The expectant mother is conscious and in control of the situation | Complete unconsciousness |
| You can see and hear the baby immediately after it is removed from the uterus | The child can be seen only a few hours after the operation |
| Numbness in the legs goes away 3-5 hours after surgery | After waking up from anesthesia, it takes time to recover |
| Headaches and back pain may occur in the postoperative period. | Cough, sore throat, headache are the most common symptoms that occur after general anesthesia |
| Less usage medical supplies helps to avoid complications in the newborn | Drugs adversely affect the nervous and respiratory system baby |
Additionally
There is another type of regional anesthesia - spinal. It differs from epidural anesthesia in that the drug is injected into the cerebrospinal fluid once, and a catheter is not used. The advantage of this method is that it is easier technical implementation and the ability to use it in emergency situations. However, there is also a drawback: the amount of the administered drug must be strictly and correctly calculated for the duration of the operation, therefore, if unforeseen surgical complications arise and the need to extend the operation time, you will have to switch to general anesthesia.
Caesarean section is considered a surgical intervention with low development potential postoperative consequences. As a rule, the trigger for complications after a cesarean section is the reason that forced one to resort to this type of delivery. For example, premature placental abruption prompts the doctor to perform emergency surgery. In this case, problems that arise in the postoperative period, first of all, arise due to early placental abruption. Most often, the urgency of the situation does not allow for spinal anesthesia (the complexity of the procedures), so general anesthesia is usually performed, during which the incidence of complications is much higher.
Read in this article
Risk factors
If a cesarean section is performed, complications after the operation can be caused by a number of factors:
- obesity;
- large fruit size;
- complications that led to the need for surgery;
- prolonged labor or surgery;
- history of several births;
- allergies to latex, anesthetics and other drugs;
- limited physical activity mothers during pregnancy;
- low blood cell count in a woman;
- use of epidural anesthesia;
- premature birth.
What complications are most common?
The following complications may occur during surgery or in the postoperative period:
- infectious;
- excessive blood loss;
- damage to internal organs;
- the need for a hysterectomy (removal of the uterus);
- blood clot formation;
- reaction to drugs;
- neurological problems (consequences of anesthesia during caesarean section);
- scarring of tissue and possible problems with subsequent childbirth;
- death of mother;
- traumatization of the child.
Fortunately, serious complications from a caesarean section are rare. Although maternal mortality with this operation is higher than in women with natural delivery. Since the reasons for which this surgical intervention is performed are quite often potentially life-threatening to the mother.
Infectious complications
The operation itself, as a result of which the abdominal wall and membranes of the uterus are dissected, causes bacteria (usually non-pathogenic from the vagina) to enter the wound surface. This can lead to the development of various infectious complications in the postoperative period.
Postoperative wound suppuration
Sometimes bacteria multiply not in the uterus, but in the abdominal wall. Infectious inflammation skin and underlying tissues to which it is applied can lead to the formation of abscesses and purulent leaks, which will require repeated surgery. But, as a rule, these complications are recognized on initial stages when treatment with antibiotics is possible.
Increased temperature, pain and redness in the area postoperative wound- symptoms that are most often encountered with this problem.
Puerperal fever and sepsis
According to some reports, 8% of women in the postoperative period may develop so-called childbed fever or postpartum fever. Usually the complication begins with inflammation of the uterus or vagina, then bacterial infection spreads throughout the body, affecting the lungs (occurs after cesarean section) and other organs.
When microbes are detected in the blood, the process is called sepsis. This is a pathology that requires long-term antibacterial treatment, and is considered the most dangerous complication, sometimes leading to fatal outcome. Fever during the first 10 days after is a sign of childbed fever. Timely initiation of treatment can prevent further development this serious complication.
Bleeding
During natural delivery, the average blood loss does not exceed 500 milliliters; during a cesarean section, it can reach 1 liter. In most cases, such blood loss is suffered by women who do not have concomitant pathology, without any difficulty. However, serious bleeding can sometimes occur and may occur during or after surgery.
Postoperative bleeding
Blood loss of up to 1 liter during a cesarean section can be considered normal. Bleeding may also occur after surgery and is usually due to clotting problems. This is an urgent situation, so if a woman notices leakage from the wound, she should immediately contact her doctor.
After stopping the bleeding, it is usually necessary recovery period within a few weeks. Sometimes blood and blood substitutes are given intravenously, iron supplements and vitamins are prescribed.
Atony
After the baby and placenta are delivered, the uterus usually contracts, causing gaping blood vessels to close. When this does not happen (a condition called uterine atony), prolonged bleeding is possible. Fortunately, doctors have very effective drugs in their arsenal to help combat this problem. Most of them contain prostaglandins. Today, delayed complications associated with uterine atony are extremely rare.
Ruptures, damage to internal organs
There are times when the incision is not large enough to remove the baby without tearing the uterine tissue. To the right and left of it there are large arteries and veins, which in this situation can be damaged and bleed. As a rule, the operating surgeon notices this in time, preventing the woman from losing a lot of blood. Sometimes he can damage nearby organs with a scalpel. Injury Bladder leads to serious bleeding and, as a rule, requires stitches to be placed on its wall.
Dense attachment and placenta accreta
When a tiny embryo moves into the uterus, cells called trophoblasts accumulate on its wall (from which the placental villi form). They penetrate the wall of the uterus in search of blood vessels. These cells are playing important role in the movement of oxygen and nutrients from mother to fetus. The fibrous layer of the uterus prevents the deep penetration of placental villi into its wall. If this layer has previously been damaged (for example, any operation on the uterus), then a condition called placenta accreta may develop, and sometimes even penetration of trophoblasts into the bladder occurs.
The danger with this problem is that serious bleeding may occur. The good news: doctors today have learned to promptly recognize this formidable complication and quickly take appropriate measures. Bad news: The problem almost always requires a hysterectomy.
Hysterectomy
Removal of the uterus is sometimes performed immediately after a cesarean section. Some complications (usually related to bleeding) force the surgeon to perform this operation to save the mother's life. Women who have had a hysterectomy can no longer have children. Apart from this terrible situation, as a rule, this operation does not have any additional problems.
Blood clots or vascular thrombosis
One of the most dangerous complications after a caesarean section - the formation of blood clots in the vessels of the legs or pelvic area. Thrombosis of the veins can lead to a blood clot breaking off and moving to the lungs, the appearance of a so-called embolism pulmonary artery. A complication that is the leading cause of death in the postoperative period. Fortunately, the appearance of blood clots in the legs is also accompanied by pain in them, which forces a woman to consult a doctor with these symptoms. Timely administration of appropriate treatment (eg, Coumadin or warfarin) is effective in preventing the development of pulmonary embolism.
Reactions to drugs, latex, anesthesia
In addition to the risks associated directly with the operation itself, there are complications that a woman may experience when using drugs, latex or anesthesia. Adverse drug reactions can range from mild (such as headache or dry mouth) to very serious (such as death from anaphylactic shock). The high incidence of these problems during cesarean section is explained by the urgency of the situation: there is not enough time to conduct allergy tests and evaluate a possible reaction to drug interactions.
In the case of planned surgery, they also occur, but much less frequently, and practically no serious reactions are observed. Sometimes the mother does not know that she is allergic to medications or has had adverse reactions associated with anesthesia. These include:
- severe headache;
- visual impairment;
- vomiting or nausea;
- pain in the stomach or legs;
- fever;
- swelling of the throat;
- severe weakness;
- pale skin;
- the appearance of a rash or swelling on the skin;
- or fainting;
- labored breathing;
- weak and rapid pulse.
Majority side effects disappears after discontinuation of the drug. Possible serious allergic reactions, but, as a rule, they are effectively managed with drug therapy. Women who have serious adverse drug reactions need immediate medical attention.
Complications and long-term consequences of anesthesia
General anesthesia for elective surgery is rarely used; as a rule, it is used for emergency situation. Regional anesthesia is divided into spinal and epidural, which numb the lower half of the body. The main difference between these types of anesthesia is where the anesthetic is injected: into the epidural or subdural space.
Complications after spinal anesthesia for caesarean section:
Complications in subsequent pregnancies
After a cesarean section, a woman may have problems with subsequent pregnancy due to the formation of scar tissue along the excision. Sometimes situations arise where the wall of the uterus and the bladder become fused, which leads to its damage during subsequent operations on the uterus. Also, women after cesarean section are more likely to experience labor weakness during natural delivery.
Risks from the child
Not only women can experience complications after a cesarean section. There are some risks associated with the fetus with this surgery. The following problems may be identified in a child:
| Problem | Why does it occur |
| Premature birth | If the gestational age was calculated incorrectly, then the baby born may be premature. |
| Breathing problems | Some studies suggest that these children have an increased risk of developing asthma in adulthood. |
| Low Apgar scores | This is the result of anesthesia, fetal distress before birth, or lack of stimulation during labor that is present as the fetus passes through the vaginal birth canal. |
| Traumatization with a surgical instrument | Very rarely skin children are damaged during surgery (on average, 1 case per 100 operations). |
A cesarean operation, like any serious operation, has complications, sometimes quite severe, threatening the lives of both mother and child. Recovery after surgery takes longer than if delivery occurred naturally. However, in order to save the life of the mother or child, one has to resort to this operation. The emergence of new drugs and methods for determining the risks associated with this operation has made it possible to maximize the safety of this type of surgical delivery; today it is actively used in obstetric practice.
