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"Emergency medicine" 6 (61) 2014

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Anesthetic Management of Cesarian Section

Authors: Pidhirnyy J. - Danylo Halytsky Lviv National Medical University; Department of Anesthesiology and Intensive Care

Categories: Medicine of emergency

Sections: Specialist manual

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Keywords

Anesthesia, Cesarian Section, antacids, local and general anes

Summary. Issues of anesthetic management of cesarian section are enlightened in this lecture. Classification of urgensy levels according to Clinical Protocol in Obstetrics "Cesarian Section" and controversies there are also shown. Preoperative preparation of pregnants in urgent and planned surgery modes and monitoring of woman in childbirth and a child are also described. 11,2 % of all pregnants experience hypotension with drop of systolic blood pressure more than 30 mm Hg after lying in supine position for several minutes. Aortocaval compression develops due to partial occlusion of Inferior cave veinand aorta by pregnant uterus. This aorto-caval compression effect can be minimized or treated by full lateral positioning on both sides.

Pregnant should be considered as person with elevated aspration and regurgitation risk.

Because of differences found in protocols for aspiration preventing depending on different clinics the problem of this complication is included in this lecture.

Current anesthetic management of Cesarian Section include TVA and regional anesthesia. In the past, epidural anesthesia seemed like method of choice for Cesarian Section in women with cardiovascular pathology or preeclampsy, due to possible avoidance of rapid hemodynamic shifts associated with spinal anesthesia. Implementation of combined spinal-epidural technique has limited the use of epidural anesthesia in this category of pregnants.

Spinal anesthesia provides faster and more efficient anesthetic block than EA. In 1996 year survey this technique was method of choice among anesthesiologists in planned or urgent surgeries.

In numeral cases in planned as well as urgent Cesarian Sections, combined sinal-epidural anesthesia is a method of choice.

It provides secure of anesthetic action and rapid block development combined with adjustable in duration sensor block using slow boluses of local anesthetic via epidural cathether. It allows to decrease intrathecal doses of local anesthetic if it`s needed thus minimizing side effects frequently seen during spinal anesthesia alone.

Issues of pre- and intraoperative block failure are also described

Pharmacokinetics and pharmacodynamics of local anesthetics, opioids and adjuvants in regional anesthesia are described as well.

Still TVA is good option for anesthetic management of Cesarian Section. Difficult intubation

andextubation protocols are in special focus and are accented.

The lecture ends with details in pharmacokinetics and pharmacodynamics of uterotonic drugs.


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