Cesarean section: which anesthesia is better? Which anesthesia is safer and preferable for caesarean

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:

Its rapid impact during an unscheduled operation.
Low risk of falling blood pressure.
Stability of the cardiovascular system.
The opportunity for a woman not to see what is happening.
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.

Specially for- Elena TOLOCHIK

At the stage of preparation for a planned caesarean section, in most cases, the mother herself can choose the method of pain relief. The two most common are general anesthesia and epidural anesthesia.

When choosing, several factors must be taken into account.

Own forces and psychological readiness. What do you prefer - to fall asleep and wake up already in the ward, or to be present at your own operation and see the baby immediately after birth?
The equipment of the hospital in which the operation will take place. It is likely that district maternity hospitals may not have the equipment to safely perform any type of anesthesia.
Qualification of doctors and medical staff. Can the anesthetist in your maternity hospital guarantee that anesthesia is performed in accordance with all standards?

The child can be adversely affected by both methods. However, with general anesthesia, the risk of complications for him is still higher, since not one, but several drugs are introduced into the mother's body at once.

Brief Comparison Table of General Anesthesia and Epidural Anesthesia

General anesthesia
Epidural anesthesia

Anesthesia drugs that depress the brain can enter the child's body
May cause a decrease in the heart rate in the child, hypoxia, respiratory failure after birth

Mom is in a medical sleep throughout the operation
Mom is conscious throughout the operation

You won't be able to see your baby until a few hours later.
Immediately after removing the baby, the mother can look at him and hold

After waking up from anesthesia, it takes time to recover
Numbness in the legs goes away after a couple of hours after surgery

After anesthesia, cough and headache are possible
May cause headache and back pain

General anesthesia

Most often, this type of anesthesia is used in emergency cases, because it takes much less time. Throughout the operation, the woman sleeps and does not feel anything.

Methodology

General anesthesia has three components. In order for the mother to fall asleep, "preliminary anesthesia" is first administered intravenously. Then a tube is inserted into the trachea (this is the lower part of the windpipe), through which a mixture of oxygen and anesthetic gas is supplied. Finally, a muscle relaxant is introduced - a drug that relaxes all the muscles of the body, including the uterus. After such triple anesthesia, the operation begins.

There are practically no contraindications for general anesthesia, but side effects and complications can be quite serious.

Side effects of general anesthesia

The most common and mild nuisance is coughing and sore throats from tube irritation. In case of incorrect execution, the voice may sit down. Sometimes there may be injuries to the lips, teeth and tongue during the rough actions of the anesthesiologist.
Frequent side effects: headache, nausea, dizziness, confusion, muscle pain;
More serious complications are respiratory tract infections, pneumonia, allergic reactions, and the inhibitory effect on the brain of narcotic drugs.

General anesthesia for caesarean is indispensable if:

There are contraindications for epidural anesthesia;
With oblique and transverse position of the fetus, prolapse of the umbilical cord;
For emergency caesarean section.

The effect of general anesthesia on a child

General anesthesia affects the child more than epidural anesthesia. Side effects may include:

Lethargy, drowsiness of the child;
Respiratory disorders;
Toxic effect on the brain and the development of perinatal encephalopathy (PEP).

Expert Arkady Kokhan, Anesthesiologist-resuscitator

With general anesthesia, drugs are used that have a slight inhibitory effect on the work of the child's respiratory center. However, the use of modern techniques and proven obstetric techniques helps the child survive birth stress and minimizes the negative effects of general anesthesia. If necessary, resuscitation measures are taken. Parents do not need to take any special action.

Epidural anesthesia

It consists in the fact that an anesthetic substance is injected into the place where the nerves exit the spinal cord in the spinal canal. All sensitivity of the lower part of the body disappears: pain, tactile and temperature. A person does not feel his legs below the waist and cannot move them.

With this anesthesia, the mother retains a clear mind. She sees and hears everything that happens around, can communicate with a doctor or husband (if he was allowed to be present). With the same method, if desired, childbirth can also be anesthetized.

Most often, epidural anesthesia is used for planned cesarean section operations, when doctors have time to prepare. The calmer the situation before the operation, the easier it is for the doctor to make a puncture and the better anesthesia passes. In an emergency, this is not always possible, especially when the woman is in labor.

Epidural anesthesia technique

Preparation starts 30 - 40 minutes before the operation. A sterile needle is used to pierce the skin above the spine at the level of the lower back. When the needle enters the space where the nerve roots of the spinal cord come out, a thin soft tube (catheter) is inserted into it, through which the medicine will flow.

Then the needle is removed and only the catheter remains, which is glued to the skin with a plaster, lengthened and brought along the back up to shoulder level. Now the doctor can inject the right amount of medication into the catheter at any time to get an analgesic effect.

If an attempt to puncture and insert a catheter for some reason fails, then, as a rule, they proceed to general anesthesia.

Contraindications for epidural anesthesia

Inflammation of the skin, pustules 20 cm in diameter from the place where the puncture should be made;
Violation of blood clotting;
Acute infectious diseases;
Allergy or intolerance to certain drugs for anesthesia (lidocaine, marcaine, etc.);
Diseases of the spine, osteochondrosis with acute pain;
Scar on the uterus - in some cases;
Oblique or transverse position of the fetus in the uterus;
Narrow pelvis or heavy weight of the child.

Side effects and complications of epidural anesthesia

With caesarean section with epidural anesthesia, side effects and complications are more frequent and more pronounced than with childbirth with it. The fact is that much larger doses of drugs are needed for the operation, and narcotic drugs (fentanyl) are often used.

In many ways, complications depend on the skill of the anesthesiologist. In most cases, they are minimal, but after the operation, discomfort may occur. Most frequent:

back pain, headache, tremors in the legs. This usually goes away after a few hours, but if the anesthesiologist makes mistakes (more often with a lack of time), the headache can remain for several days and, in rare cases, for several months.

More rare complications:

urination disorders - rarely occur and usually disappear after a few days;
allergic reactions - may occur in rare cases. The operating room has everything you need to eliminate them;
spinal cord or nerve injury - directly depends on the anesthesiologist. It happens very, very rarely and, as a rule, in difficult cases.

Some women are frightened by the feeling that numb legs cause, as if they were cut off, or they are strangers.

The effect of epidural anesthesia on a child

This is due to the fact that painkillers can pass from the mother's bloodstream through the placenta to the baby. Side effects directly depend on which drugs are used: it can only be anesthetics (lidocaine, marcaine, etc.) or narcotic drugs (fentanyl, etc.)

A decrease in the heart rate of the child - occurs due to a decrease in pressure in the mother and a deterioration in blood flow in the placenta;
Hypoxia - occurs as a result of a decrease in the frequency of heart contractions;
Respiratory disorders after birth - occur after the use of narcotic drugs and sometimes require ventilation.

With a competent pediatric neonatologist, all these complications can be easily overcome.

In general, the harm from epidural anesthesia for a child is much less than with general anesthesia and there is practically no effect on the brain that is characteristic of anesthetic drugs.

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

But you are preparing for a planned caesarean section and still have a choice. Therefore, we will dwell in detail on each of the possible types of anesthesia offered by modern medicine.

Which anesthesia is better for caesarean section

There are three types of anesthesia:

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

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

Indications for the appointment of epidural anesthesia for caesarean section

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

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

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

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

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

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

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

Epidural anesthesia for caesarean section: video

Spinal anesthesia for caesarean section is common in modern maternity hospitals. This method of anesthesia during surgery has several advantages. The selection of anesthesia is carried out by a doctor. The specialist studies the course of pregnancy and the history of the woman. Only based on the data obtained, the anesthesiologist determines the type of anesthesia.

Caesarean section is a traumatic intervention in the reproductive system. The operation is accompanied by damage to several tissues. To avoid the development of pain shock, doctors use a variety of painkillers.

Three types of anesthesia are used for caesarean section: deep form of anesthesia, spinal or subarachnoid anesthesia, epidural anesthesia. The choice depends on the reasons for the caesarean section.

Many clinics use anesthesia. This method allows you to adjust the process of surgical intervention. Also, a specialist can choose a drug suitable for long sleep. But European maternity hospitals rarely use anesthesia. Spinal or epidural anesthesia is preferred. The difference between these methods lies in the features of the introduction of the drug into the spinal canal.

Epidural anesthesia uses a catheter. It is installed in the intervertebral space. Through it, the active substance is injected. Spinal anesthesia is performed using a thin long needle. It is inserted into the spinal space. An anesthetic is injected through the needle.

All of these techniques have their pros and cons. To choose the right method of anesthesia, you need to consult a doctor. He will explain what problems may arise after surgery. Also, the specialist will select a method suitable for each patient individually.

Positive aspects of the procedure

Spinal anesthesia has several advantages over conventional anesthesia. This method is recommended for the following reasons:

The positive effect is the complete preservation of consciousness. Spinal anesthesia applies only to the lower torso. The brain and thoracic region are working normally. This method of performing a caesarean section gives a woman a chance to control the process and attach the baby to the breast in the first minutes after birth. After anesthesia, the patient needs some time to restore the brain. Spinal anesthesia excludes the post-anesthetic state.

Many women are afraid of a caesarean section due to a psychological condition. Fear of the unknown during surgery is accompanied by the development of stress. For this reason, anesthesia in this way avoids additional inconvenience. The child is immediately shown to the mother. A woman can watch as doctors weigh and measure the baby.

The average duration of action of the drug is 120 minutes. This time is enough to carry out all the necessary manipulations. In this case, the patient does not experience any pain. The drug relieves the sensitivity of the abdominal zone, lower extremities and small pelvis. At the end of the surgical intervention, the newly-made mother can perform the usual activities without additional inconvenience. After ordinary anesthesia, recovery is required within two days. Consciousness returns completely after this period. Spinal anesthesia excludes this stage of postoperative recovery. On the day of surgery, the patient can perform a number of permitted activities.

The positive side is the speed of onset of drug activity. The first signs of the action of the drug appear after five minutes. Ten minutes later, the woman can be operated on. This effect is used for emergency caesarean section. If natural childbirth is not accompanied by the opening of the uterus, doctors inject an anesthetic and caesarean woman.

What else do you need to know

Any prescription of the drug must be carried out by a doctor. Many drugs have a negative effect on the child. Medicines used for spinal anesthesia do not affect the condition of the fetus. This effect is due to the peculiarity of its introduction. The active substance blocks the work of the nerve endings of the spinal column. Due to this, the effect of anesthesia is achieved. Absorption of the drug into the bloodstream is slow. Since the fetus receives all harmful and beneficial substances through the placenta, anesthesia does not cause harm.

When using anesthesia, part of the substance is absorbed into the bloodstream. The first day after a caesarean section, the child may be lethargic, poorly takes the breast.

Unlike many drugs used for anesthesia, the anesthetic has a minimal amount of side effects. The development of adverse reactions is possible, but rarely diagnosed.

Negative points

Spinal anesthesia also has a number of disadvantages. Unpleasant moments should not be excluded. The following negative consequences of the intervention may occur:

soreness in the puncture area;
partial numbness of the lower extremities;
migraine headaches;
a sharp decrease in body temperature;
hypotension.

During the first week after a caesarean section, there may be pain in the area of the puncture. Often the pain radiates to the lumbococcygeal region. Discomfort is relieved with analgesic drugs. After a few days, the pain disappears.

In some patients, partial numbness of the lower extremities is revealed. The problem occurs suddenly and also quickly passes on its own. Leg numbness may occur for several months after a caesarean section. In the first days after surgery, this problem is more pronounced. If the sensation in the legs does not return on the next day after the operation, it is necessary to inform your doctor about it. The specialist will conduct a medical examination and identify the cause of such a complication.

Migraine headache is a common problem. The pain affects the temporal and parietal zone. There may be blurred vision and tinnitus. Not always such pain can be completely eliminated by a specialist. For some women, pain appears during their lifetime due to temperature changes or changes in weather conditions. You should be aware that anesthesia can cause a more complex pathology. Many patients who have gone through anesthesia later suffer from migraines of a long course.

Spinal anesthesia is injected into the spinal canal. Decreased sensitivity of nerve endings affects body temperature. In the first minutes after the administration of the drug, the woman has a fever. After a caesarean section, the temperature drops periodically. After a month, this pathology disappears spontaneously.

The main problem for many women in labor is hypotension. Pathology is characterized by a sharp decrease in blood pressure. The problem arises from the interruption of the nerve impulse. Hypotension disappears after 3-4 months. But for some mothers, it remains for life. Critical conditions should be avoided by additional therapy. Well helps from this disease taking vitamin-mineral complexes.

Risks of the proposed method

Spinal anesthesia has several risks. Before performing a caesarean section, the specialist must carefully study the patient's history. The presence of any pathologies can affect the course of the surgical intervention.

If there is a risk of a long course of the operation, anesthesia is not used. The effect of the drug is 2 hours. In some cases, drugs with a duration of up to four hours are used. If a longer surgical intervention is expected, spinal anesthesia should be abandoned.

The experience of the medical worker introducing spinal anesthesia is also important. Not every doctor can correctly deliver the drug. If the worker has little experience or practice, the effect of anesthesia may not occur or be short-lived. Rarely, edema develops due to improper administration of the drug. To avoid such a pathology, you need to consult with your doctor and ask the opinion of patients who have undergone spinal anesthesia.

Rarely, a future mother has an allergic reaction. A few days before the caesarean section, the doctor asks the patient for allergic reactions to various drugs. A study of the reaction to the proposed active substance is also being conducted. If the expectant mother develops swelling or a rash, this drug should not be used. But it is not always possible to conduct this study. Cesarean section is also carried out on an emergency basis. To avoid unpleasant consequences, doctors monitor the patient's condition during surgery.

Prohibitions for using the method

Spinal anesthesia is not always allowed for caesarean section. This method of anesthesia has several contraindications. There are the following prohibitions:

long course of late toxicosis;
pathological increase in intracranial pressure;
problems with blood clotting;
heart disease;
hypoxic injury to the child.

It is forbidden to use spinal anesthesia with a long course of late toxicosis. This form of toxicosis is accompanied by the loss of a large amount of moisture. The removal of fluid is accompanied by a decrease in the volume of cerebrospinal fluid. There is some bleeding during the operation. If the patient needs a caesarean section, anesthesia is used.

Pathological increase in intracranial pressure precludes the use of many drugs. Spinal anesthesia affects spinal pressure. A sudden drop in pressure causes the heart to stop. The choice of method of anesthesia is carried out by the anesthesiologist.

The main contraindication is the reduced coagulability of the blood fluid. During surgery, tissues and many small vessels are injured. If spinal anesthesia is used, the risk of large blood loss increases. Surgery is also excluded with the constant intake of anticoagulant drugs. These medicines thin the blood. The blood loss will be significant. This pathology calls into question a caesarean section.

Spinal anesthesia is not prescribed for problems with the cardiac system. A variety of heart defects and mitral valve disorders preclude the use of many drugs. The entire course of the operation is developed by several specialists.

In some situations, the child also suffers from various ailments. Hypoxia is considered a common pathology. The disease is accompanied by a lack of oxygen. The fetus experiences oxygen starvation. In this case, a caesarean section is performed using anesthesia, since natural childbirth also becomes impossible.

Preparatory activities

Caesarean section requires some preparation of the patient. The use of spinal anesthesia is also accompanied by a number of preparatory measures. A few days before surgery, the following activities are carried out:

study of the composition of the blood fluid;
cancellation of concomitant therapy;
fetal monitoring.

A woman needs to donate blood from a vein for research. Specialists study blood for quantitative and qualitative composition. An elevated level of leukocytes and lymphocytes indicates the development of latent inflammation. A low red blood cell count can also be a problem during surgery. If the analysis is normal, the doctor proceeds to the next stage of preparation.

Some women have chronic pathologies that require constant medication. Reception of anticoagulants must be excluded. This will help prevent bleeding during a caesarean section. Hormone therapy is also cancelled. If a woman is undergoing ongoing therapy, she should inform the doctor.

It is not only the woman who is subjected to scrutiny. The condition of the child is also being studied. For this purpose, ultrasound diagnostics is used. It is necessary to determine whether the fetus develops correctly, whether it has any problems. The work of the child's heart is also studied. For this study, a special apparatus is fixed on the patient's abdomen, which responds to the work of the fetal heart. All data from it is sent to the computer. Only after all of the above measures is selected the method of anesthesia.

Characteristics of the procedure

Spinal anesthesia is simple. For the introduction of the drug, a woman needs to lie on one side. The legs are bent at the knees and pressed against the thoracic region. In the upper part of the lumbar spine, the skin is treated with an antiseptic solution.

The anesthetic is drawn into a special syringe with a long, thin needle. The puncture zone is highlighted with a special napkin. The needle is inserted between the vertebrae. When passing through the wall of the spinal cord, there is little resistance. It indicates the selection of the correct site. The drug is injected into the cavity. The needle is removed.

From this point on, you need to monitor the patient's condition. The first sign of the onset of the action of the substance is a feeling of fullness in the puncture zone. Next, the woman notices a loss of sensation in one leg, then the second limb is taken away. After that, the stomach becomes numb. You can have a cesarean section.

Pregnancy is a wonderful period in a woman's life. Childbirth does not always go according to plan. If the patient is scheduled for a caesarean section, do not be afraid. In this case, spinal anesthesia is often used for caesarean section.

In certain cases, childbirth cannot go naturally, and then an operation is performed - the newborn is removed from the mother's womb through an incision made in the uterus. Without anesthesia, it is impossible, like any other surgical intervention. Therefore, the question of which anesthesia for cesarean section is better is very relevant.

If the operation is planned, the doctor discusses the choice of anesthesia with the patient, offering his options. If you had to cesarean urgently, the doctor makes his own decision. To date, general (including endotracheal) anesthesia and regional (spinal, epidural, spino-epidural) anesthesia are used.

Modern surgeons and anesthesiologists do not welcome, but still sometimes they are forced to do intravenous general anesthesia during caesarean section, which does not have the most favorable effect on the fetus and the woman in labor.

This is an artificially induced inhibition of the central nervous system, which is accompanied by sleep, loss of consciousness and memory, muscle relaxation, a decrease in some reflexes, and the disappearance of pain sensitivity. This condition is a consequence of the introduction of general anesthetics, the doses and combinations of which are individually selected by the anesthesiologist.

Indications

The doctor prescribes a caesarean section under general anesthesia intravenously in the following cases:

there are contraindications to spinal and epidural anesthesia: coagulopathy, acute bleeding, thrombocytopenia;
oblique or transverse position of the fetus;
morbid obesity;
prolapse of the umbilical cord;
placenta accreta;
previous surgery on the spine;
refusal of the woman in labor from regional anesthesia;
emergency caesarean section.

If these indications are available, a caesarean section is performed under intravenous general anesthesia.

Advantages

Despite the fact that most clinics have now abandoned the use of intravenous general anesthesia during caesarean section, it still has a number of advantages. These include:

complete anesthesia;
maximum muscle relaxation, which is very convenient for the surgeon;
fast action of anesthetics, which allows you to perform the operation instantly, when every minute counts;
does not affect cardiac activity;
does not provoke pressure drop;
the doctor constantly controls the depth and duration of anesthesia;
The technique for administering drugs for general anesthesia is extremely simple, medical errors are excluded, and expensive equipment is not required.

Despite all these advantages, intravenous general anesthesia is rarely offered to women in labor who are going to have a caesarean section. Like any other anesthesia, this one has its pros and cons, and the latter are often decisive for refusing this type of anesthesia.

Flaws

Doctors do not hide the fact that the consequences of general anesthesia intravenously during a cesarean section can be dangerous to the health and even the life of the baby. It is because of this that it is abandoned in favor of spinal or epidural anesthesia.

The obvious disadvantages of this procedure include:

high risk of complications;
respiratory disorders in the baby;
a depressing effect on the nervous system of the fetus, which will be expressed in its excessive lethargy, lethargy, drowsiness, while at such a moment activity is required from it;
aspiration - the release into the trachea of the contents of the stomach;
hypoxia in a woman in labor;
when connected to a ventilator (artificial lung ventilation), a woman in labor may have an increase in pressure and an increase in heart rate.

The risk of health complications in the baby in the future is too great if a caesarean section is performed under intravenous general anesthesia. And this is the main drawback of this type of anesthesia, which crosses out all its positive aspects.

Therefore, doctors dissuade women in labor from this technique and resort to it themselves only in the most urgent cases. So be sure to find out under what kind of anesthesia a caesarean section is performed in the hospital where you will have the operation.

It is interesting! Scientists from the United States have found that the state of a person under anesthesia is more like a coma than sleep.

Endotracheal general anesthesia

General anesthesia also includes endotracheal anesthesia, which is used in the case of a caesarean section. The pain medication enters the cells of the body through a tube that the anesthetist inserts into the windpipe. Most physicians, if a delivery operation cannot be avoided, choose this particular technique. Her indications are exactly the same as those of general intravenous anesthesia, but there are much more advantages.

pros

Doctors prefer endotracheal general anesthesia during caesarean section for the following reasons:

the drug crosses the placenta more slowly than with its intravenous administration, so the risk of undesirable consequences for the fetus is much less;
the risk of complications for the respiratory and cardiovascular systems is minimized, since the device removes carbon dioxide from the body and supplies the lungs with oxygen;
anesthetics are given in a more precise amount, and the dosage of the drug substance can be changed at any time;
the doctor monitors the level of oxygen saturation and the volume of ventilation received by the lungs;
the contents of the stomach cannot enter the lungs.

So when asked which anesthesia is better for cesarean section - intravenous or endotracheal, doctors most often answer unequivocally: the latter option is preferable. Still, this type of general anesthesia has its drawbacks.

Minuses

The organisms of a woman in labor and a baby can react differently to drugs administered through general endotracheal anesthesia. As a result, the consequences of such an operation are sometimes not only unpleasant, but also dangerous to health. Among them:

nausea;
sore throat, muscles;
shiver;
dizziness up to fainting;
weak consciousness;
injuries of the tongue, lips, teeth, throat;
lung infections;
allergy;
anaphylactic shock;
brain damage in both the mother and the baby;
as well as damage to the nerve processes in both.

Even doctors cannot always predict the negative consequences of endotracheal general anesthesia, especially in the context of delivery, when they are responsible for the life of the mother and child. Therefore, recently regional types of anesthesia have been used for caesarean section, which have a less harmful effect on the fetus: spinal, epidural and spino-epidural.

through the pages of history. In ancient times, during childbirth, electric ramps were used as a kind of anesthesia.

spinal anesthesia

Local (regional) spinal anesthesia for caesarean section provides blocking of all types of sensitivity. In some sources, it may be called spinal. It consists in the fact that the drug is injected through a puncture between the vertebrae into the cerebrospinal fluid. In this case, the needle is inserted much deeper than with epidural anesthesia.

The second difference of this technique is the position of the woman in labor with the introduction of an anesthetic. With an epidural, she sits, while here she will be asked to lie down in the fetal position, tucking her legs under her stomach as much as possible.

Indications

For caesarean section, spinal anesthesia is performed in the following cases:

emergency situation, and general anesthesia is contraindicated;
performed epidural anesthesia at the beginning, which must be completed by caesarean section;
preeclampsia;
heart disease;
arterial hypertension;
diabetes;
kidney problems.

This is a gentle type of anesthesia that doctors resort to if a woman in labor has any serious health problems. However, spinal anesthesia has a number of contraindications that must be kept in mind.

Contraindications

There are the following contraindications to spinal anesthesia during caesarean section:

refusal of the patient from this type of anesthesia;
lack of necessary equipment or a qualified specialist;
big blood loss;
disorders associated with the circulatory system;
any infections, inflammations, sepsis,;
allergy to the administered drug;
heart problems;
high intracranial pressure;
diseases of the central nervous system;
the use of heparin, warfarin or other anticoagulants immediately before surgery.

If at least one contraindication from this list has not been taken into account, the most serious complications can await the mother and child after spinal anesthesia used during caesarean section. That is why, if an operation is performed, a woman should discuss with her doctor all the problems of her health and decide whether this type of anesthesia is suitable for her or not. It has its own advantages and disadvantages.

pros

The most common question asked by women in labor preparing for a caesarean section is which is better: spinal or epidural anesthesia? The choice will largely depend on the individual characteristics of the female body, the course of pregnancy and many other factors. Benefits of spinal anesthesia:

excellent pain relief without the errors that occur with epidural anesthesia;
excellent relaxation of the muscular system;
speed of action: only 5-7 minutes;
minimal effect of drugs on the fetus: with epidural anesthesia, the volume of the injected substance is much larger;
the ability to be conscious throughout all childbirth;
due to the decrease in pressure, doctors can control blood loss;
passes faster and much easier than after general anesthesia;
the use of a thinner needle than with epidural anesthesia, so that pain at the puncture site is subsequently excluded;
no risk of spinal cord injury;
lower price.

In the question of which anesthesia to choose (epidural or spinal) for caesarean section, the price does not at all determine the quality. Here it is lower only because the volume of the administered drug is much less than that used for epidural anesthesia. And, of course, not a single type of anesthesia can do without drawbacks.

Minuses

In rare cases, the consequences of spinal anesthesia as part of a caesarean section can be as dangerous as with general anesthesia. So the woman in labor should know in advance about all the shortcomings of this type of anesthesia, which include:

high professionalism of the anesthetist is required;
complications include infection, meningitis, toxic poisoning, convulsions, respiratory arrest, spinal cord injury, death, severe headaches or back pain that can last for several months after surgery;
due to an incorrect puncture, anesthesia may not work at all;
the anesthetic is weak, but still can affect the child;
limited (no more than 2 hours) time of action of the anesthetic drug:
a sharp drop in pressure in a woman in labor, which is accompanied by bouts of nausea and dizziness.

So, if you have to go through a caesarean section, it is worth weighing all the pros and cons of spinal anesthesia before using this method of anesthesia. Despite the low cost compared to epidural anesthesia, sometimes it makes sense to use the latter option.

significant date. On October 16, 1846, Thomas Morton (an American dentist) performed an operation under anesthesia. This date around the world is now considered the Day of the anesthetist.

Epidural anesthesia

Recently, more and more often, with a planned caesarean section, epidural anesthesia is used, which does not require such accuracy and professionalism from the anesthesiologist as with spinal anesthesia. These two types of anesthesia are very similar, but you need to understand the differences in order to make the right choice.

Differences from spinal anesthesia

Can't decide which type of anesthesia to prefer? In this case, find out in advance how epidural anesthesia is done, what is its difference from spinal anesthesia. After all, each of them will have its own consequences for your body and for the health of the baby.

Begins to act 20, not 5 minutes after the administration of the drug.
The anesthetic is injected into the epidural space of the spine, not into the cerebrospinal fluid.
The needle is much thicker.
It is inserted between the spinal canal and the dura mater, and not between the vertebrae.
The insertion of the needle is much more superficial than with spinal anesthesia.
A catheter is inserted, which remains in the spine throughout the operation. With spinal anesthesia, such a tube is absent.
More expensive, since the volume of the drug that is injected into the body is much larger.

As for the side effects that a woman can experience right on the operating table, there can be no definite answer. Different women in labor may experience different sensations under epidural anesthesia and spinal anesthesia. Some feel only a slight tingling sensation when the needle is inserted, while others experience convulsions if a nerve is inadvertently touched. So it all depends on the level of pain threshold and individual characteristics.

Indications

if it was already performed at the beginning of natural childbirth, but surgical intervention was urgently required;
serious diseases in a woman in labor: preeclampsia, high blood pressure, problems with the kidneys or liver, severe myopia,;
premature pregnancy;
contraindications for general anesthesia;
excessive labor activity, pathology of the cervix;
the wish of the mother.

If a problem arises, which is better: general anesthesia or epidural anesthesia, the doctor looks first of all at the health of the expectant mother. The last option of anesthesia is more gentle and has a minimum negative effect on the fetus. It is for this reason that at present, preference is given to regional methods of anesthesia.

Contraindications

When preparing for a caesarean section, it is imperative to take into account all the contraindications to epidural anesthesia, of which there are a lot. Otherwise, serious complications and irreversible consequences may occur. You can not use this technique in the following cases:

having problems with blood clotting;
bleeding;
increased intracranial pressure;
tattoo on the back, affecting the puncture site;
infections, inflammations, tumors, wounds and any other lesions of the skin at the puncture site;
allergy to a drug;
epilepsy;
elevated temperature;
arrhythmia;
intestinal obstruction;
heart disease;
diseases of the central nervous system;
traumatic shock;
cardiovascular, posthemorrhagic collapses;
diseases of the spine and spinal cord;

For a day, women in labor are often contraindicated for the injection of Clexane used for the treatment and prevention of thrombosis. If for some reason these contraindications were not taken into account, there may be consequences of epidural anesthesia during caesarean section, which pose a danger to the health of the mother and child. If the prenatal examination was thorough, this type of anesthesia does not contain any obvious pitfalls: it has many advantages.

Advantages

Here are some benefits of epidural anesthesia for caesarean section:

complete anesthesia;
not such a strong effect on the fetus, as with general anesthesia;
a woman has the opportunity to see her baby immediately after the operation;
epidural anesthesia for caesarean section lowers blood pressure so that the surgeon can control blood loss during the entire operation;
the postoperative period is much easier to bear;
the catheter allows you to control the dosage of the anesthetic - this is the main advantage of epidural anesthesia, which spinal does not have.

Like other types of anesthesia for caesarean section, epidural has its drawbacks, which are expressed primarily in a huge number of consequences for the health of the mother and child after surgery.

Flaws

The disadvantages of epidural anesthesia, which is used for caesarean section, include:

erroneous injection of the drug into the vessel can provoke convulsions, a sharp decrease in pressure, which lead to death or serious brain damage;
a decrease in pressure can cause a woman to experience severe dizziness and an attack of nausea right during childbirth;
the drug introduced into the body will still have some effect (and negative) on the fetus;
if the caesarean section is not completed within 2 hours due to unforeseen complications, the epidural will have to be extended.

The most serious drawback of this type of anesthesia used during caesarean section is the consequences after epidural anesthesia, sometimes too dangerous and irreversible. It's almost impossible to predict them.

Effects

As a result of non-compliance with contraindications or individual characteristics of the mother's body, complications of epidural anesthesia sometimes occur after cesarean section. They can affect the health, even the life of both the mother and the child.

Complications for the mother during childbirth:

damage to the dura mater;
decrease in heart rate;
nausea, vomiting;
chills;
spinal cord injury;
back pain;
toxic reaction to the drug.

Postpartum consequences for a woman:

severe head and back pain;
problems with lactation;
loss of sensation in the lower extremities;
CNS disorders.

Complications for the child:

decrease in heart rate;
respiratory failure, motility;
disorientation;
difficulty sucking;

If the spouses who are about to become parents face the problem of which anesthesia is better for caesarean section, it should be solved only together with your doctor. After a thorough and circumstantial examination, he can draw conclusions and advise the most suitable option. Otherwise, the consequences of epidural anesthesia will not be long in coming. In rare cases, doctors decide to do a spinal-epidural (epidural-spinal) anesthesia.

Curious fact. One chance in 200,000 is the chance that a woman in labor will die from anesthesia.

Spinal epidural anesthesia

Combined epidural-spinal anesthesia is a method that combines both types of anesthesia. Spinal anesthesia is performed, but with catheterization. Allows you to use the advantages of both and offset their shortcomings. It was widely used during operative delivery not so long ago, but it has proven itself just fine. An increasing number of doctors are leaning towards this method of pain relief.

Knowing in advance that you will have to give birth with the help of surgery, find out in more detail what kind of anesthesia is done for a caesarean section in the maternity hospital where you are going to go to the operation. This will allow you to fully prepare for it, find out all the pitfalls, and resolve controversial, dubious issues with the doctor. The calmer mother is before a significant event, the smoother and better it will go.