Caesarean section is a fairly common delivery operation. Every year the frequency of its holding increases. Knowledge of the features of selection and application spinal anesthesia will help a woman prepare for the birth of a child and protect herself as much as possible from unpleasant consequences.
Indications for caesarean section and types of anesthesia
Spinal anesthesia for caesarean section most often used when available the following factors: uterine scar from previous surgery, breech presentation or fetal oxygen deficiency, anatomically narrow pelvis, complications during natural childbirth. In some cases, doctors take into account non-medical indicators, such as the age of the primigravida over 30 years, the risk of damage to the pelvic floor, and the desire of the pregnant woman. Contraindications include unfavorable fetal condition (prematurity, death, deformities, prolonged oxygen starvation), clinically significant infection, protracted labor more than 24 hours.
Pregnancy causes serious changes in the body of the expectant mother, including hormonal ones. They have great importance for an anesthesiologist, because only taking them into account can a woman be given qualified assistance. It usually decreases arterial pressure due to decrease vascular resistance, respiratory rate and tidal volume, oxygen consumption increase, and gastric motor activity decreases. These changes in the functioning of the body directly affect the characteristics of anesthesia. The most commonly used methods of reducing pain during childbirth are psychoprophylaxis, systemic and regional anesthesia.
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Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult your doctor!
Many patients during preparation for planned operations I am interested in what the consequences of epidural anesthesia during childbirth may be. After all, this method of pain relief is still little known to ordinary people.
The epidural space in humans is located along spinal column. It envelops the hard protective sheath of the nerve roots and the spinal cord itself.
Epidural (peridural) anesthesia helps block the transmission of nerve impulses at the location of the nerve roots. As a result, a decrease in intensity or complete suppression is achieved pain. The anesthetic is administered directly into the epidural area (space) using a specially designed catheter.
Such anesthesia is performed by administering various painkillers. This allows you to perform the procedure with varying degrees actions.
Analgesia leads to loss of pain sensation. Anesthesia is necessary for complete loss of sensation. Muscle relaxation is performed to relax muscle tissue and reduce pain intensity.
Indications for epidural anesthesia during childbirth
Epidural anesthesia is a medical procedure that poses a certain degree of danger to the patient. Peridural anesthesia can cause side effects, has contraindications and is fraught with negative consequences. Only an experienced specialist should administer the drug.
Preliminarily carried out full examination patient, careful examination of the history and results laboratory research. Based on the data obtained, the anesthesiologist and the specialist performing the primary treatment of the patient make a decision on the admissibility of the procedure in a particular case.
Carrying out such anesthesia is prescribed during obstetrics (especially during caesarean section), during urological and gynecological operations. Spinal anesthesia is also used for surgery in the lower extremities, perineum, and pelvic organs.
Drugs used
Involves application various drugs to achieve the desired effect. All injected solutions undergo intensive purification and are freed from preservatives. This increases their effectiveness and safety for the patient.
The main drugs for epidural anesthesia are local anesthetics:
- bupivacaine;
- lidocaine;
- ropivacaine.
To intensify the analgesic effect, opiates are additionally used:
- buprenorphine;
- morphine;
- promedol;
- fentanyl.
IN special cases The following are added to the solution for epidural administration: medical supplies, How:
- clonidine;
- ketamine;
- physostigmine.
The specific composition of the injected solution is determined strictly individually. Its dosage is selected at the rate of 1 or 2 ml of liquid per individual segment of the spinal cord that needs to be blocked. Defining Moments - clinical picture and the patient's health status.
Contraindications to the procedure
The main contraindications to the use of epidural anesthesia are:
Possible consequences
Spinal epidural anesthesia causes various consequences that pose a danger to the patient's body. Some of them can be predicted in advance. Then it is better to refuse this type of pain relief. Some complications arise unexpectedly and for no apparent reason.
The degree of danger in a particular case is determined by factors such as:
- age and general state patient;
- composition of the anesthetic solution;
- correct procedure.
Basic Negative consequences similar anesthesia is:
Some consequences gradually disappear as the body is resuscitated postoperatively. Dangerous complications require special treatment.
Epidural anesthesia for caesarean section
Such anesthesia is increasingly used during obstetrics, relieving the young mother of the pain caused by the birth of a child. Epidural anesthesia for caesarean section, planned or emergency, is preferred general anesthesia. The woman in labor remains fully conscious.
She can see her baby immediately after birth and hear his first cry. Therefore, many expectant mothers who are prescribed to give birth by caesarean section ask to replace general anesthesia with epidural anesthesia.
The final decision is made, of course, by specialists: obstetricians, anesthesiologists, pediatricians. After all, complications after epidural anesthesia are possible not only for the woman in labor, but also for the baby.
Consequences of epidural anesthesia during childbirth
If exceeded required dose anesthesia, a woman in labor may experience:
- toxic effects on the brain;
- a sharp decrease in blood pressure;
- development of convulsive syndrome;
- respiratory disorder;
- heart failure.
If the specialist administering the anesthetic is not highly qualified, the needle or catheter used during the procedure may injure the nerve roots of the spinal cord. In case of non-compliance required level sterility around the injection site, infection begins and inflammatory process. Very often in such a situation, septic meningitis begins.
A sharp decrease in blood pressure causes general weakness, nausea, and vomiting. In this case, to stabilize the condition, it is enough to correct the pressure with the help of special medications.
If there is an error in administering the anesthetic, the dura mater of the spinal cord may be punctured. This causes severe post-puncture headaches and general weakness. Therefore, bed rest and absolute rest are prescribed for at least a day.
When a significant dose of anesthetic solution enters a blood vessel, severe intrasystemic intoxication occurs. Injury to the spinal cord roots leads to the development of severe pain in the back and spine. In this case, it is also possible to limit physical activity.
Epidural anesthesia during childbirth - consequences for the child
The results of special studies do not yet allow us to give an unambiguous answer to the question about the danger of epidural anesthesia for a child. The main factors that can cause negative consequences are:
It is reliably known that the epidural anesthetic administered to a young mother during natural childbirth, significantly reduces the child’s activity. This makes it difficult for him to be born, reduces the rate of passage of the fetus through birth canal. In this case, there is a need to use vacuum extraction, forceps and other methods of assisting during childbirth. This can cause serious injury to the newborn.
If, after the administration of an anesthetic solution, a woman begins severe trembling, the child experiences a significant lack of oxygen. Further dangerous consequences Epidural anesthesia leads to various kinds of problems with breastfeeding.
Complications of epidural anesthesia during abdominal surgery
The use of epidural anesthesia during surgery is carried out to partially relieve pain in certain areas of the patient’s body, in addition to general anesthesia and to relieve postoperative pain. Anesthetics, opioids and other drugs used for anesthesia may have side effect on the patient's body. Specific complications in this case depend on dosage violations, incorrect procedure, individual characteristics health status.
Many complications that appear after epidural pain relief go away over time without treatment or are easily eliminated with the help of medical supplies. These include:
- shiver;
- itching and goosebumps all over the body;
- drop in blood pressure;
- partial or complete immobility;
- back pain;
- partial numbness or loss of sensation in case of damage to nerve fibers.
Serious problems are caused by a break in the catheter through which the anesthetic is administered. In this case, it is necessary to perform a special surgical intervention to remove the broken end stuck in the spinal canal.
An error when administering an epidural injection, leading to bone injury, subsequently causes severe pain in the spine and back area. To eliminate them, a special course of treatment is required.
Headaches after epidural anesthesia can have a different threshold of intensity. If they occur as a side effect of the administered anesthetic, then they are easy to stop. Over time, the syndrome goes away. In the case when the epidural needle pierces the dura spinal cord, in order to relieve the patient of headaches, the puncture has to be repeated. When an accidental puncture is blocked, pain syndrome will gradually pass.
Any convulsions and difficulties in performing natural functions (especially when urinating) can be eliminated by taking appropriate medications. Additionally, a course of physiotherapy and other healing procedures is prescribed.
Epidural anesthesia is used as the main type of pain relief. This type regional anesthesia is highly effective and has few side effects. Let's look at it in more detail, highlighting the indications, features and contraindications.
Epidural anesthesia - indications
Epidural anesthesia for cesarean section is carried out at the request of the woman in labor. Many expectant mothers who are assigned plan section, give preference directly to this type of anesthesia. With such anesthesia, the woman remains conscious, hears the first cry of her baby, but feels absolutely nothing. There are also factors in the presence of which epidural anesthesia is mandatory for cesarean section. Among them:
- Availability ;
- high blood pressure;
- liver and kidney diseases;
- severe myopia;
- diabetes;
- contraindications to general anesthesia;
- excessive labor;
- pathological conditions of the uterus.
How is a caesarean section performed with epidural anesthesia?
Women preparing for surgery often ask doctors how a caesarean section is performed with epidural anesthesia. Before the beginning surgical intervention The pregnant woman sits down on the couch or lies on her side. The area of the spinal column where the needle is inserted is carefully treated with an antiseptic. After the onset of anesthesia, doctors make an incision in the lower abdomen, slightly above the pubis. On surgical wound expanders are applied, allowing access to the fetus.
After carefully opening the amniotic sac, doctors begin to remove the fetus. After successfully completing this stage, the baby's umbilical cord is cut and a clamp is applied. The mother is given Oxytocin to remove the placenta. After this, suturing is performed. After a few months, a scar remains at the site of the suture, which is practically invisible and does not cause any inconvenience to the mother.
How is epidural anesthesia given for caesarean section?
Epidural anesthesia for caesarean section is often administered in a sitting position. In this case, the patient is asked to take a position: spread her legs at the knees, put her ankles on the bed, bend her back, tilting cervical region. An alternative is to position the woman lying on her side (usually on the right). However, medical practice shows that it is easier to administer the anesthetic with the patient in a sitting position.
An anesthetic, using a special needle, is injected into the space between the wall of the spinal canal and the dura mater of the spinal cord (epidural space). A special, thin, sterile tube (catheter) is inserted through the needle, which is left in place to administer the anesthetic. Epidural anesthesia during a caesarean section involves dosing the drug: increasing the concentration or stopping its supply.
Is it painful to have an epidural after a caesarean section?
A procedure such as epidural anesthesia is practically painless for the patient herself. Before the puncture, doctors carry out local anesthesia. Slight discomfort slight pain a pregnant woman can feel it only at the moment of puncture. Otherwise, the procedure does not cause pain and is well tolerated by pregnant women. The expectant mother's worries about the pain of such a procedure as epidural anesthesia during a caesarean section are groundless.
How long does a caesarean section last with epidural anesthesia?
A caesarean section under epidural anesthesia lasts no more than half an hour. In this case, on average, from the moment of insertion to the removal of the fetus from the abdomen, 10-15 minutes pass. The rest of the time is spent on suturing postoperative wound. At the same time, the woman is given a hormone to expel and deliver the placenta. To prevent infection, the mother is also given antibacterial drugs.
Caesarean section under epidural anesthesia - sensations
With proper anesthesia, the woman does not feel anything during the operation. The sensations experienced during caesarean section under epidural anesthesia are associated with the onset of action of the anesthetic. After the injection, the pregnant woman begins to notice warmth and a feeling of heaviness in her legs. Over time future mom does not feel completely bottom part torso - everything below the injection site. Mild numbness spreads throughout the body. This phenomenon may be accompanied by slight tingling, a feeling of goosebumps, which disappears after complete anesthesia.
How long does epidural anesthesia last after cesarean section?
Epidural anesthesia for caesarean section lasts about 2 hours. Immediately during this time, doctors forbid the woman to get up after the operation. With this type of anesthesia, blood flow in lower limbs slows down. Because of this, if you try to stand up, your legs become weak and there is a high risk of falling. In addition, headaches and dizziness often occur after surgery, which worsen the well-being of the new mother.
Epidural anesthesia for caesarean section - consequences
Consequences after epidural anesthesia during cesarean section are often associated with non-compliance with contraindications to its behavior or with a violation of the pain management algorithm itself. In this case, complications can be observed both on the part of the mother and the baby. It is worth noting the consequences of epidural anesthesia for a woman in labor (during childbirth):
- injury to the dura mater of the spinal cord;
- decreased heart rate;
- the appearance of nausea and vomiting;
- allergic reaction to anesthetic.
Disorders can develop in a new mother in the postpartum period:
- back and head pain;
- violation ;
- decreased sensitivity in the legs;
- dysfunction of the central nervous system.
Poorly performed epidural anesthesia for caesarean section can also affect the condition of the baby:
- decreased heart rate (bradycardia);
- disruption of the breathing process;
- disturbance of the sucking reflex;
- disorientation;
- encephalopathy.
Back pain after epidural anesthesia for cesarean section
Epidural anesthesia for cesarean section, the consequences of which are mentioned above, often results in back pain for a woman after the birth of the child. There could be many reasons for this. Epidurit is an inflammatory process in the epidural space that is dangerous. This complication develops due to the long stay of the catheter in the back or when part of it remains. In addition, pain may worsen after surgery due to an existing vertebral hernia.
Other causes of back pain are directly related to improper conduct of a procedure such as epidural anesthesia for caesarean section, and the body’s reaction to the anesthetic. Due to the lack of extensive experience, the doctor can injure you with an injection needle. hard shell where the nerve roots are located. Separately, it is necessary to highlight phantom pain, which is associated directly with psychological state patients.
Headaches after epidural anesthesia for cesarean section
When talking about the consequences and complications of epidural anesthesia for caesarean section, it is necessary to highlight frequent headaches after surgery. Their appearance is associated with the effect of the anesthetic component on the body. This reaction is observed in 50% of patients who have undergone epidural analgesia. Duration painful sensations– from several hours to several weeks. Headache can also be caused by a change intracranial pressure, due to expiration cerebrospinal fluid into the epidural space (if the membrane of the brain is damaged).
Such situations require surgical intervention. The operation consists of repeated puncture and suction of fluid using a special device. After the manipulation, a blood patch is placed at the puncture site. The patient's blood taken from a vein is injected into the puncture site. As a result, the outflow of cerebrospinal fluid is blocked. The woman notices relief in her state of health the very next day after the procedure.
C-section is a special operation during which, using surgical intervention, abdominal cavity mothers take out the child. This operation is permissible in cases where a woman cannot give birth on her own. If a caesarean section was warned in advance, then the woman has time to choose exactly how she can relieve pain in her body.What anesthesia is better for caesarean section?
Today, doctors use several methods of anesthesia: general, epidural and spinal. In order to choose the right suitable for a woman anesthesia, the following question must be resolved: does she want to be conscious or not? Of course, for a child, anesthesia in any form is not very pleasant, but general anesthesia is the most dangerous. Indeed, during the use of such anesthesia, two or even more drugs are introduced into the mother’s body.Epidural anesthesia for caesarean section
During this type of anesthesia, the doctor injects an anesthetic into the lumbar region of the back. The main advantage of this anesthesia is that the woman is constantly conscious. In addition, the anesthetic does not act immediately, but gradually, and thereby minimizes the negative impact on the nervous system and heart. It is also possible to do some movements. In most cases, epidural anesthesia is used when complications arise during childbirth or they are delayed. But it is contraindicated for women who have a disease such as asthma. Since epidural anesthesia is not the most the best way affects Airways.It is also worth noting that epidural anesthesia should only be performed by a specialist, because otherwise it is possible that due to large dose anesthetic, convulsions occur. Sometimes there may also be severe headache, which will not be so easy to get rid of. IN medical practice cases have been observed that result in complex neurological disorders. Epidural anesthesia should not be used if you have problems with blood pressure.
Spinal anesthesia involves injecting an anesthetic into the spinal cord at the lumbar level and during this procedure the membrane that protects the spinal cord is pierced. spinal cord. With this type of anesthesia, the needle is inserted slightly deeper than with epidural anesthesia. Doctors believe that it is safer and has a number of advantages.
For example, it relieves pain much better during the entire period of use spinal anesthesia There hasn't been a single failure yet. Also, no systemic toxicity was observed. It is much easier to insert and within a few minutes the operation can begin. But with all of her positive qualities Not without its downsides. For example, it begins to act very sharply, which does not have a very good effect on the nervous system and significantly reduces blood pressure. Sometimes complications arise because the dose was insufficient. In this case, it is necessary to use either another type of anesthesia, or reinsert the catheter.
General anesthesia for caesarean section
This type of anesthesia is used when epidural or spinal anesthesia cannot be used. Namely, when blood pressure is high or there are pathologies. When a doctor administers an antiseptic, a woman’s consciousness and sensitivity are completely switched off. Its significant advantage is that it is relatively safe if used correctly and the woman does not feel a severe headache after the anesthesia wears off.General anesthesia acts very quickly and allows the muscles to completely relax, which will affect the quality of the surgeon’s work. Therefore, most doctors are only for this anesthesia. But despite positive sides General anesthesia also has negative qualities, of which there are many. During its action, the woman may experience hypoxia and there is a significant risk that tracheal intubation cannot be used, and if this is not done, the woman may suffocate without the help of a breathing apparatus. There may also be problems with nervous system and this anesthesia does not have a very good effect on the child himself, because a certain amount of narcotic elements reaches him through the placenta.
Indicators for general anesthesia
- Unstable condition of the fetus;
- The need for rapid delivery;
- Contraindications to regional anesthesia;
- At the request of the woman and refusal of regional anesthesia;
- A woman's heavy weight, which becomes pathological.
But it's worth remembering that general anesthesia has a much worse effect on the child.
Over the past half century, Caesarean section has become a widely used delivery procedure, in which the baby is delivered through an incision in the uterus. This became possible thanks to the use of antibiotics, which significantly reduced the death rate statistics.
Indications for planned caesarean section
- The presence of mechanical obstacles that prevent natural delivery;
- Discrepancy between the width of the mother’s pelvis and the size of the fetus;
- Transverse position or breech presentation of the fetus;
- Multiple pregnancy;
- Kidney diseases and of cardio-vascular system in a woman;
- There is a threatening rupture of the uterus, for example, there is a scar on it from a previous birth;
- The appearance of genital herpes in the third semester of pregnancy;
- A woman's desire.
Types of anesthesia for caesarean section
Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!
