Anesthesia for caesarean section: types, consequences, which is better, contraindications. How is general anesthesia performed for a caesarean section?

If during pregnancy the mother has indications for surgical delivery, then she is prescribed a planned operation. It consists in removing the newborn from an incision in the abdomen and uterus. Like any abdominal operation, caesarean section requires mandatory anesthesia. Often, patients are given a choice of type of anesthesia, and many of them stop at the "epidural". Epidural anesthesia for caesarean section has specific features, advantages and disadvantages, which must be considered when choosing anesthesia.

There are several commonly accepted anesthesia options that are widely used for caesarean section. These include:

1. General anesthesia. With such anesthesia, the woman is in an unconscious state, she is immersed in a drug-induced sleep, in which there is no understanding of what is happening and sensitivity. In endotracheal general anesthesia, a special tube is inserted into the trachea, which communicates with the device that performs pulmonary ventilation. Such anesthesia begins to work almost instantly, so it is used when urgent surgical intervention is needed.
2. 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 the thinnest needle into the cerebral fluid of the spinal canal. The procedure is almost painless, does not cause much discomfort, except for a slight feeling of pressure. To inject the anesthetic, the woman should lie on her side, press her knees to her stomach. As a result, the mother does not experience any pain during the delivery process, she remains conscious throughout the operation, and after removing the baby, she will immediately be able to see him.
3. Epidural anesthesia, like spinal anesthesia, refers to regional types of anesthesia. According to the mechanism of action and conduction, it is close to spinal, although it has several differences.

Each technique is good in its own way, but there are contraindications. More often than other types, epidural anesthesia is used for caesarean section.

Epidural pain relief

Anesthesia by 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 accuracy as spinal anesthesia, since the drug is injected into the epidural spinal cavity. A needle is inserted between the spinal dura and the wall of the brain canal, through which the catheter passes. Then the needle is removed, and an additional dose of anesthetic can be injected through the remaining catheter, if necessary.

It is not uncommon for epidural anesthesia to be used in traditional childbirth to eliminate pain and ease the process of natural delivery in women with overly heightened perception of pain. After the administration of 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 mind and can contact doctors. After a caesarean section, this anesthesia lasts for several more hours.

If during the epidura the anesthetic injection technique was violated, then anesthesia can only spread to half of the body. If for some reason epidural anesthesia cannot be done, then a caesarean section is performed under general anesthesia.

How anesthesia is carried out

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. A woman takes laboratory tests for determining Rhesus, blood type, hemoglobin and erythrocyte cells, leukocyte and platelet counts. Be sure to conduct a coagulogram for the concentration of prothrombin and fibrinogen.

After all the above procedures, with the approval of epidural anesthesia, 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 pressure, and an oxygen mask is prepared. The woman is laid on her side and anesthesia is injected between the lumbar vertebrae, which is most often used as Lidocaine.

Throughout the operation, the patient is carefully monitored, which involves monitoring respiratory functions and hemodynamic parameters such as pulse, heart rate and blood pressure. The effect of the epidura usually lasts for several hours after the operation.

Benefits of an epidural

Doctors can do this anesthesia for caesarean section in two ways: with or without a catheter. When a catheter is inserted, a small dose of anesthetic is initially injected, and then an additional dose is administered if necessary. If the catheter is not installed, then the drug is immediately injected in a large dose so that its effect is enough for the entire operation.

The use of "epidural" during surgical delivery has some advantages, for example, the absence of side oxygen starvation of the fetus and the woman in labor, which is observed during general anesthesia against the background of repeated insertion of the tracheal tube or due to an incorrectly configured pulmonary ventilation apparatus. There are other advantages of such anesthesia:

• During the entire caesarean procedure, the patient is in full consciousness and understanding of what is happening around, so it remains possible to hear and see the baby immediately after it is removed;
• There is no irritant associated with damage to the airways 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 sufficiently long analgesic effect, therefore it is successfully used in natural childbirth, a caesarean section is done with it, etc .;
• It is allowed to use anesthesia not on an empty stomach, while with general anesthesia, abstinence from food is required.

Epidural analgesia is very effective against postoperative pain syndrome, when appropriate drugs are injected through the catheter after the intervention, so this 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 such as diabetes mellitus or preeclampsia, heart defects or hypertension, and various kidney diseases. In addition, the “epidural” is performed in a situation where, at the beginning of natural childbirth, 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 shown in case of premature pregnancy, if the pregnant woman has hepatic disorders, with cervical pathologies or excessive uterine activity. If the general type of anesthesia is contraindicated, then the woman in labor is also performed a caesarean section with epidural anesthesia.

Epidura, in comparison with general anesthesia, is a more gentle and safe procedure for the child, but when choosing anesthesia, the specialist always assesses the general condition of the woman in labor and the fetus.

Disadvantages of epidural anesthesia

Although there are many advantages, epidural anesthesia for caesarean section has some disadvantages. Such injections help to reduce blood pressure, which in some situations can provoke a pronounced nausea attack and severe dizziness during the operation. If the technique of administering the anesthetic is not observed, convulsive seizures and a rapid decrease in pressure may occur, which is fraught with serious brain damage and even death.

It is impossible to exclude the influence of drugs on the fetus, although it does not enter the child’s body directly, it can negatively affect him through complications on the mother’s body. If, for any reason, the delivery operation is extended for more than a two-hour period, then the epidur will have to be extended, i.e., higher doses of anesthetic medication will be administered. It can also negatively affect the newborn.

Contraindications to anesthesia of this type

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 anesthesia to a woman if she herself refuses it. In addition, it is impossible to provide full-fledged epidural analgesia in the absence of the necessary equipment, materials, and also the specialization of the anesthesiologist. Also contraindications include:

Therefore, when choosing such anesthesia, it is necessary to take into account these contraindications. Otherwise, there is a high risk of developing undesirable consequences that are dangerous for the fetus and mother.

Possible adverse reactions and negative consequences

Usually, epidural anesthesia rarely causes any complications, but if the anesthesia technique is not followed, the patient may face similar consequences. A 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 cessation of the therapeutic effect of the drug. Spontaneous shivering is also considered a normal response to guidance, which subsequently resolves on its own.

If sterility is violated at the puncture site, inflammatory processes may occur, for the elimination of which the use of topical antibiotics in the form of solutions or ointments is indicated. If during the operation a woman's pressure drops sharply, then the consequences of epidural anesthesia in the form of a nausea-vomiting reaction are possible, which is eliminated by normalizing blood pressure. For this, cardiotonic drugs like Methasone 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 introduction the anesthesiologist mistakenly pierced the hard bone marrow, then the woman in labor will subsequently experience pronounced headaches. In such a situation, daily bed rest is necessary, it is allowed to get up only the next day. Such an appointment is due to an increase in pressure in the spinal canal in a vertical position, as a result of which fluid flows out, leading to headaches. In addition to bed rest, the use of painkillers like Analgin, etc. is indicated.

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. With the erroneous introduction of an anesthetic into the vessel, the development of acute systemic intoxication is possible. To avoid this, an aspiration check is performed or a test dose is applied. According to statistics, adverse reactions or complications occur when contraindications to the use of such anesthesia are not observed.

There is no such anesthesia, which would not have any contraindications. If a cesarean 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 taken into account. There are specific criteria by which the most optimal pain relief is determined.

1. The general condition of the woman in labor and the presence of a history of certain pathologies. If the patient has reduced blood clotting or pathologies such as lumbar osteochondrosis are present, then spinal and epidural anesthesia is unacceptable. If there are cases of hyperthermia of a malignant nature in the family history of the pregnant woman, then general anesthesia is contraindicated.
2. Estimated duration of the procedure. If additional surgical manipulations are planned during 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, but less deep. With any regional anesthesia, a decrease in pressure is noted, which, with a long-term effect, can lead to fetal hypoxia.
3. Accounting for indications for a delivery operation. In case of emergency intervention, the choice falls on general anesthesia, because it acts instantly. A planned cesarean allows the use of local types of anesthesia, in which the woman will be conscious, so that she can see the baby immediately after extraction and hear his first cries.

Local methods of anesthesia are less dangerous for the patient and the baby, but the final choice is determined jointly with the doctor on the basis of a specific case.

What do the doctor's say

Doctors insist that epidural anesthesia is permissible only according to relevant indications. Today, many patients, because of the rhinestone before childbirth, literally require similar anesthesia during natural, uncomplicated childbirth. Usually, women in labor begin to require pain relief when the delivery is almost over. And at this time, anesthesia 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 in the spinal structures, rather than a harmless anesthetic injection. Even with the availability of modern safe, reliable and improved medical technologies, the possibility of complications cannot be ruled out. Therefore, epidural anesthesia is the optimal method of anesthesia for caesarean section, but it is better to refuse it during natural childbirth.

What is the best anesthesia for caesarean section?

Epidural anesthesia for caesarean section

It is also worth noting that epidural anesthesia should only be done by a specialist, because otherwise it is possible that convulsions occur due to a large dose of anesthetic. Also, sometimes a severe headache may occur, which will not be so easy to get rid of. In medical practice, cases have been seen that end in complex neurological disorders. Epidural anesthesia should not be used for problems with blood pressure.

Spinal anesthesia involves injecting an anesthetic into the spinal cord at the level of the lower back and during this procedure the sheath that protects the spinal cord is pierced. 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 anesthetizes much better and for the entire time of using spinal anesthesia there has not yet been a single failure. Also, no systemic toxicity was observed. It is much easier to insert and after a few minutes you can start the operation. But with all its positive qualities, it was not without its minuses. For example, it begins to act very abruptly, which does not have a very good effect on the nervous system and significantly reduces blood pressure. Sometimes complications arise due to the fact that the dose was insufficient. In this case, it is necessary to apply either a different type of anesthesia, or re-insert the catheter.

General anesthesia for caesarean section

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 the positive aspects of general anesthesia, there are also negative qualities, which, moreover, are many. During its action, hypoxia of the woman may occur and there is a significant risk that tracheal intubation cannot be applied, and if this is not done, the woman may suffocate without the help of a breathing apparatus. Problems with the nervous system may also arise, and this anesthesia does not have a very good effect on the child himself, because a certain amount of narcotic elements enters him through the placenta.

Indicators for General Anesthesia

1. Unstable condition of the fetus;
2. The need for rapid delivery;
3. Contraindications to regional anesthesia;
4. At the request of the woman and the refusal of regional anesthesia;
5. The large weight of a woman, turning into pathology.

But it is worth remembering that general anesthesia has a much worse effect on the child.

If, for some reason, a pregnant woman has to give birth surgically (through a caesarean section), then one of the most important issues will be the choice of the method for performing such an operation, or rather, the method of anesthesia.

Today, obstetricians use three types of anesthesia during cesarean birth: general anesthesia, epidural and spinal anesthesia. The first is resorted to less and less as an outdated method, but there are situations when it is the only possible way of pain relief. Preference today is given to two other types of anesthesia as safer and easier in terms of implementation and in terms of "departure" from anesthesia. They have other advantages, as well as disadvantages, of course.

The decision on the method of conducting a CS (caesarean section) is made by the doctor together with the patient. In many respects, it depends on the state of health of the mother and the unborn child and on the characteristics of the course of this pregnancy. But the desire of the woman in labor also plays an important role.

Today we offer a closer look at spinal anesthesia in childbirth, since among all types it is the highest priority for Western, and domestic doctors too.

Spinal anesthesia for caesarean section: pros and cons, consequences, contraindications

Like epidural, spinal (or spinal) anesthesia refers to regional anesthesia, that is, a method of anesthesia in which the sensitivity of a certain group of nerve impulses is blocked - and the effect of anesthesia occurs in the part of the body necessary for medical manipulations. In this case, the lower part of the body “turns off”: the woman does not feel pain below the waist, which is enough for painless comfortable childbirth and unimpeded comfortable work of doctors.

A huge advantage of regional anesthesia is that the mother remains conscious, can think and speak clearly, understand what is happening to her and is able to see, pick up and even attach a newborn baby to her breast immediately in the first minutes of his life.

If we talk specifically about the spinal method of administering an anesthetic, then it has such advantages compared to other methods:

• Rapid onset of action. Drugs administered for pain relief during spinal anesthesia begin to act immediately. About two minutes - and doctors can already prepare the abdominal cavity for surgical intervention. This is of particular importance when CS has to be performed unscheduled, on an emergency basis: in this case, spinal anesthesia is a priority choice and life-saving remedy.
• Very effective pain relief. The analgesic effect reaches 100%! This is a big plus not only for the woman in labor, who participates in the process, but does not feel pain, but even a huge advantage for obstetricians who can do their work in comfortable conditions. This requires less than with epidural anesthesia, the amount of anesthetic drugs.
• No toxic effects on the mother's body. Unlike other methods, this one is quite gentle in terms of negative effects on the woman's body. In particular, intoxication of the central nervous and cardiovascular systems is minimized.
• Minimal risks to the fetus. With a properly selected and administered dose of anesthetic, the baby does not experience any negative effect of the drug, the baby's respiratory centers (as with other types of anesthesia) in this case are not oppressed. It is for this that the majority of women in labor who are due to give birth by CS are worried.
• Ease of carrying out. The choice of a qualified specialist is of paramount importance, and in this regard, a woman will have fewer fears and worries, because spinal anesthesia is easier to perform. In particular, the anesthesiologist has the ability to feel the "stop" of the needle, so there is no risk of inserting it deeper than is acceptable.
• Application of a fine needle. The needle itself is thinner than that used for epidural anesthesia. This allows pain relief with a single injection of the drug without placing a catheter (as with an "epidural").
• Minimal postoperative complications. After a few days (and sometimes even hours), the newly-made mother can lead a normal life - move, get up, take care of the child. The recovery period is very short and easy. The resulting consequences in the form of headache or back pain are minor and short-lived.

Meanwhile, spinal anesthesia also has disadvantages:

• Short duration. The blockade of nerve impulses that transmit pain persists for several hours (from one to four depending on the type of drug, but on average within two hours) from the moment the drug is administered. Usually this is enough to safely take delivery. But in some cases, a longer time is required. If such situations are known in advance, then another type of anesthesia is preferred.
• Possibility of complications. In this case, much depends on the professionalism of the anesthetist and obstetric staff. But even with quality work, some complications are not excluded, because each organism individually reacts to such interventions and influences. In particular, so-called post-puncture headaches often occur (in the temples and forehead), which can persist for several days; sometimes loss of sensation in the legs persists for some period and after the operation is completed. It is also important to prepare for spinal anesthesia, in particular, to introduce drugs that prevent a strong sharp drop in blood pressure, which occurs very often during spinal anesthesia. If the dose of the anesthetic was calculated inaccurately, then it is no longer possible to administer the drug additionally, otherwise neurological complications are possible.
• Presence of contraindications. Unfortunately, this type of anesthesia is not always applicable. It is impossible to resort to spinal anesthesia in cases where there are complications and circumstances requiring a longer action of anesthesia, and when the woman took anticoagulants on the eve of childbirth. Among the contraindications to spinal anesthesia are any blood clotting disorders, severe cardiac pathologies, CNS dysfunction, exacerbation of herpes infection and other infectious and inflammatory processes, high intracranial pressure, patient disagreement, fetal hypoxia. Do not perform such an operation with a large loss of fluid or blood by a woman.

Despite the presence of some disadvantages, this type of anesthesia for caesarean section is the most beneficial in many respects, including from a financial point of view: spinal anesthesia is cheaper than epidural.

Spinal anesthesia technique for caesarean section

As we have already noted, the technique of such anesthesia is simple to perform. A specialist using a very thin needle makes a puncture in the lumbar region (between the vertebrae) and injects an anesthetic into the subarachnoid space - into the cerebrospinal fluid that fills the spinal canal. Thus, the sensitivity of the nerve fibers passing here is blocked - and the lower part of the body is “frozen”.

Spinal anesthesia requires a puncture of the membrane surrounding the spinal cord. This shell is quite dense, that is, the anesthesiologist feels the moment of its puncture, which allows him to accurately determine when the needle "entered" the right place and avoid unwanted complications.

Drugs for spinal anesthesia are administered to the woman in labor in the position on her side (more often on the right), but it is also possible while sitting. At the same time, it is very desirable that she press her legs bent at the knees as high as possible to her stomach.

A woman at the time of the injection of the drug practically does not feel pain, except for a slight, very short-term discomfort. Soon a feeling of numbness of the lower extremities sets in - and the operation begins.

It should be mentioned that during the planned CS with spinal anesthesia, some preparation is required, which the woman in labor will certainly be told about. In particular, on the eve of the operation, you can not drink and eat, take sedatives and blood-thinning drugs. After the operation, you will need to stay in bed for a while and drink plenty of water. If necessary (according to the results of a study of the condition of the woman in labor), medications are prescribed to relieve unwanted symptoms (nausea, itching, urinary retention, chills, etc.).

Feelings during spinal anesthesia: reviews

No matter how much we study the theory, not least we are also interested in practice. And so women go to the forum and ask women who have already given birth in this way a lot of questions: how does a caesarean section work with spinal anesthesia, does it hurt, is it dangerous, is it scary, what effect does it have on the child, and so on.

You can easily find on the net a lot of reviews, descriptions and even whole stories about how a particular woman gave birth, including with the use of spinal anesthesia. They talk in detail about everything: what sensations they experienced at the time of the injection of the medicine, how long the birth lasted, how they felt the next and a few days after the operation.

But if all this is summed up, then the main conclusions, according to the stories of women, will be the following:

1. The biggest disadvantage of spinal anesthesia for CS is fear. It’s just scary, because it’s still an operation, it’s still anesthesia, it’s still unknown (how everything will go, how the body will react, how the doctors will work). In practice, it turns out that everything ends wonderfully! Women are very happy with such childbirth. But fear is inevitable for many.
2. Very often, after the introduction of an anesthetic, there is a sharp drop in blood pressure - shortness of breath occurs, it becomes very difficult to breathe. This is not dangerous: doctors immediately give the woman in labor an oxygen mask and administer medications - and her condition quickly stabilizes. If you use drugs for prophylactic purposes, then such side effects can be completely avoided. The same applies to sedatives: taking them in advance allows you to avoid "shaking" during and after such childbirth.
3. Quite often, after such childbirth, mothers suffer from back pain, and they even have to resort to painkillers. But such pain after cesarean does not always appear, it is not always very strong, and, as a rule, it lasts no more than 2-3 days.
4. Even for some time after the operation, sometimes there may be attacks of trembling, aching pain at the injection site, numbness.

Individual reactions to anesthetics are never excluded. In separate cases, women note a burning sensation in the lower extremities, loss of sensitivity in them for a long time after surgery, persistence of headaches, especially in an upright position, vomiting after surgery, and poor tolerance to low temperatures. But these are all exceptional cases. However, if numbness or pain at the injection site persists for more than a day after CS, then this should definitely be reported to the doctors.

In general, women who have experienced spinal anesthesia during cesarean section note that it does not hurt, the postoperative period is quite favorable, and that they do not find any special negative points in this, being satisfied with the results. Especially those who have something to compare with, that is, in which the previous birth took place under general anesthesia.

And therefore, if such childbirth is coming to you, then there are no reasons for unrest. If operative delivery is inevitable, then spinal anesthesia for caesarean section in the absence of contraindications is really the best solution.

Good luck to you!

Especially for - Margarita SOLOVIEVA

Often, delivery in our time takes place with the help of a caesarean section. This is the extraction of the baby through an incision in the wall of the peritoneum and uterus of a woman. This operation is possible due to the use of anesthesia. We will learn in detail about its types and features in obstetrics.

Anesthesia for such an operation in our time, there are three types: general anesthesia, and spinal. The last two doctors are also called regional anesthesia. So, briefly about each type.

General anesthesia is rarely performed by anesthesiologists today. But if there is a need for an unscheduled operation under force majeure circumstances, then it is he who is involved. The essence of general anesthesia is the introduction of a drug to the woman in labor, which immerses her in a state of deep sleep. Next, a tube is inserted into her trachea, which supplies oxygen with anesthetic gas. With this type of anesthesia, the expectant mother is unconscious. The advantages of general anesthesia include:

1. Its rapid impact during an unscheduled operation.
2. Low risk of falling blood pressure.
3. Stability of the cardiovascular system.
4. The opportunity for a woman not to see what is happening.
5. Absolute relaxation of the muscles of the woman in labor.

As for the “minuses” of general anesthesia, this is, first of all, the possible effect of anesthetic drugs on the fetus, which manifests itself in the oppression of its muscular and respiratory systems. Also, a disadvantage is the difficult exit of the woman in labor from the state of anesthesia.

But it is worth considering the fact that medicine improves the drugs used for this type of anesthesia, which every day minimizes the risks of a negative impact on mother and child. The goal of regional anesthesia, including spinal and epidural, is local anesthesia. The essence of these two types of anesthesia is identical and consists in puncturing the lumbar region of the spine and thus supplying anesthetics to the woman's body. That is, the similarity of the spinal and epidural procedures is that their result is anesthesia of only the lower zone of the body of a woman who is in a conscious state. The main difference between the types of regional anesthesia is the dose of painkillers and the depth of the puncture for their administration.

So, spinal (it is also called spinal) anesthesia is carried out both planned and unscheduled, provided that the medical team has at least 10 minutes of time. Anesthesia with this type of anesthesia is very fast, the woman in labor does not feel pain. The advantage of this type of anesthesia is the complete elimination of the risk of negative effects of drugs on the child. At the same time, the woman is in a conscious state, which eliminates breathing problems. She hears the first cry of a child. But the disadvantages of this type of anesthesia include a high risk of a drop in a woman's blood pressure, a short effect of drugs and a rather high risk of neurological complications.

Epidural anesthesia differs from the previous type in the mechanism of drug administration, the action of which develops over 20 minutes.

The "advantages" of this type of anesthesia is that the woman in labor is conscious and the opportunity to see the child immediately after birth. It is also a gradual decrease in pressure, which minimizes the risks of its fall in mommy. An important advantage of this type of anesthesia is that the effect of administered drugs can be prolonged.

The disadvantages of epidural anesthesia are that sometimes it does not work or works partially, anesthetizing only one half of the woman's body.

Such anesthesia is quite difficult to carry out. He needs a certain level of professionalism of the anesthesiologist. Also, its disadvantage is the possibility of a so-called spinal block if the puncture for anesthesia is made incorrectly. With the introduction of too large a dose of painkillers, it is possible to stop both breathing and the heart. It is worth noting the risk of the influence of drugs on the unborn baby.

There are a number of contraindications for regional anesthesia. Among them are spinal injuries and bleeding in a woman, hypotension, intrauterine hypoxia of the baby.

Especially for- Elena TOLOCHIK

Before a caesarean section, a woman in labor is offered a choice of several types of anesthesia. Most often, doctors advise epidural anesthesia, in which a woman remains conscious, but does not feel the body below the waist. This is a type of spinal anesthesia for caesarean section. Consider the effectiveness of this type, its advantages and disadvantages, as well as other types of anesthesia with such surgery.

Varieties of anesthesia

There are the following types of anesthesia for caesarean section:

Undoubtedly, it is the first type of anesthesia in the absence of contraindications that is the safest and most easily tolerated by patients. Consider the technology of caesarean section under epidural anesthesia.

How is epidural anesthesia performed?

Epidural anesthesia for caesarean section is a type of regional anesthesia that involves pain relief in a specific part of the body. In the case of a caesarean section, the lower part of the body. How is the procedure?

The anesthesiologist conducts anesthesia 40 minutes before the start of the operation. The action of the drug begins after 20 minutes. Using a sterile needle, a puncture is made in the lower part of the spine and enters the epidural space. This is the area between the intervertebral discs and the membrane of the spinal cord, where the nerve endings are located. The drug is injected directly into the cerebrospinal fluid. After the puncture, the needle is removed, and only the catheter is left. It is through him that the anesthetic comes in.

The tube is brought up the back on the shoulder so that it is convenient for the anesthesiologist to regulate the level of drug intake.

During the administration of the drug, you need to listen to the recommendations of the doctor. It is necessary to sit straight and not move so that the doctor does not hit the spinal cord with a needle. Of course, during contractions it is difficult to sit up straight, but this is necessary so that complications do not arise.

After the onset of the drug, the woman ceases to feel the lower part of the body. She feels no pain, no touch. Despite this, the upper body remains sensitive and the woman sees and hears everything.

If it was not possible to make a puncture and put a catheter, then a caesarean section is performed under general anesthesia.

Consider the advantages and disadvantages of this type of anesthesia compared to others.

Advantages and disadvantages

Like any type of anesthesia, epidural has its advantages and disadvantages. The pluses include the following:

But any surgical intervention, which is accompanied by the introduction of anesthetics, causes side effects.

Very often, women after epidural anesthesia complain of severe headache and back pain, while after general anesthesia, only headache is noted.

The disadvantages of spinal anesthesia include:

• the likelihood of fetal hypoxia, cardiac arrhythmias and respiratory disorders in the child;
• in case of an overdose of the drug, toxic poisoning is possible, up to a lethal outcome;
• partial effect of anesthesia. In some cases, the pain reliever does not work, the woman may partially feel the lower body;
• the introduction of a drug into the spinal space requires the skill of a doctor, otherwise there is a high risk of complications;
• the occurrence of pain during the puncture.

If the puncture is done incorrectly or a large dose of anesthetics is injected, a spinal block develops, and the woman's breathing and heart may also stop.

During the introduction of anesthesia, the doctor can hook the nerve, which causes numbness of the limb. This is normal and should not cause concern, but if the spinal cord is touched, it can paralyze the lower body.

Indications and contraindications

Epidural anesthesia is not suitable for all women. In the following cases, this type of manipulation is not carried out:

In this condition, epidural anesthesia is not performed. But there are cases when this manipulation is vital, because another type of anesthesia will not work. Such cases include:

1. Violation of blood flow in the placenta. This condition causes fetal hypoxia, and as a result of oxygen starvation, malformations in the development of the child develop. Epidural anesthesia improves blood flow and prevents hypoxia.
2. Cardiovascular diseases. Natural childbirth, like general anesthesia, is a test for the heart, but epidural anesthesia does not put an additional burden on the cardiovascular system.

In the above cases, spinal anesthesia is indispensable. Consider what complications may arise after such manipulation.

What are the complications associated with epidural anesthesia?

The likelihood of side effects and complications with this type of anesthesia during surgery is much higher than during labor with anesthesia itself.

During surgery, large doses of anesthetic may be required, so most often narcotic drugs are administered with it. They not only negatively affect the woman's body, but also harm the child himself.

Common side effects include back pain, headache, and seizures. Such symptoms disappear after two hours after the operation, but with the introduction of large doses of the drug due to the fault of the anesthesiologist, the pain may not go away for several days.

In addition to mild complications, severe ones also occur, but they are rather an exception. These complications include:

• violation of urination;
• allergy (with individual intolerance to certain drugs);
• spinal cord or nerve injury (very rare).

In addition to the possible negative effects on the mother, anesthesia can harm the baby. If through the bloodstream of the mother, painkillers enter the placenta, then complications appear in the newborn. The type of side effects depends on the administered anesthetics and their doses.

When using drugs, the following problems may occur:

• decrease in heart rate in a child. Most often, this problem appears with low pressure in a woman in labor;
• fetal hypoxia. Appears due to a previous complication;
• respiratory failure after birth. Most of these children require mechanical ventilation.

All of the above complications are not terrible if qualified help is provided to the baby in time.

But still, the harm to the baby and his mother is much lower than from general anesthesia.

Both of these types of anesthesia are referred to as regional anesthesia. They are very similar to each other, because they contribute to the anesthesia of a certain part of the body, and not the introduction to a state of sleep. In addition, an injection during spinal anesthesia is made in the lower back. The difference with the epidural type is that the drug is injected into the fluid that is around the spinal cord. Only one injection is made, after which the needle is removed. With epidural anesthesia, the needle is also removed, but a catheter with a plastic tube is left, through which the drug solution is gradually injected.

Also, the differences between these two types include:

1. Spinal anesthesia works in 15 minutes, and epidural - in 20-30 minutes.
2. If anesthesia is not observed in the spinal form, general anesthesia is done, but with epidural anesthesia, a large dose of medication can be administered and the problem eliminated.
3. Side effects, in the form of headache, are more common with spinal anesthesia.

As you can see, epidural anesthesia is more easily tolerated by women and safer for health than other types of pain relief.