What anesthesia is used for caesarean section. The benefits of epidural anesthesia

When a pregnant woman undergoes emergency surgery, there is little choice. But if a planned intervention is prescribed, the patient can independently choose the type of anesthesia.

Caesarean section is prescribed to women according to the presence of absolute or relative indications. Absolute indications include clinical situations in which natural delivery is physically impossible. In such cases, childbirth must be carried out only through surgery, even if there are any contraindications to it. In a similar way, babies are helped to be born if the mother has a pelvis that is too narrow, through which even the newborn’s head cannot pass.

In addition, a cesarean section with anesthesia is performed in the presence of mechanical obstacles, which can be uterine fibroids, ovarian tumors, etc. These tumors are detected by ultrasound diagnostics, based on the results of which a planned CS is prescribed. Pregnant women are also undergoing Caesarean sections if there is a threat of uterine rupture. A similar risk occurs if there is a postoperative scar on the uterus after a previous cesarean section or other operations on the uterine body. A CS can be performed using various types of anesthesia.

Types of anesthesia for cesarean section

Today, many children are born through Caesarean section (CS). The technique of performing a CS today is so improved that it is the most reliable and safe method of giving birth to a full-fledged and healthy baby in cases where natural delivery is impossible. For many pregnant women, the prospect of going under a surgical scalpel is not exciting, but the health of the child comes first.

Just a few years ago, the types of anesthesia for caesarean section were not particularly diverse, because only a general type of anesthesia was used, as with other abdominal surgical interventions. But today there are several more types of anesthesia: general, endotracheal anesthesia and regional anesthesia, which is represented by epidural and spinal anesthesia.

In order for a pregnant woman to be able to choose the preferred anesthesia, she must first familiarize herself with all types of anesthesia, study their disadvantages and adverse consequences.

General anesthesia for caesarean section involves pain relief, in which the patient is immersed in an artificial medicated sleep. Today, the use of such anesthesia is usually due to emergency situations, because such anesthesia has a fairly high risk, but does not take much time.

General anesthesia for caesarean section involves intravenous administration of anesthetic. When it begins to take effect, the woman is put on a mask through which anesthetic gas and oxygen are supplied. Then a muscle relaxant drug is administered, which relaxes all muscle tissue. Only after all these manipulations does the operation itself begin.

Pros and cons

Surgery with general anesthesia has its positive and negative aspects.

Among the advantages of general anesthesia are:

With this anesthesia, maximum relaxation of all muscle groups is achieved, which gives the doctor a wide range of surgical manipulations;
A properly performed caesarean section under general anesthesia provides absolute pain relief;
General anesthesia begins to act quite quickly, and immediately after administration you can begin surgical procedures, which is very convenient if emergency caesarean section is necessary;
With such anesthesia, there is no such negative factor as a decrease in blood pressure in a pregnant woman;
Such anesthesia does not cause depression of cardiac activity;
A simple technique that does not require additional equipment or qualified skills;
The anesthesiologist can keep the duration and degree of anesthesia sleep under control and, if necessary, increase its duration.

The disadvantages of general anesthesia come down to the following factors:

Indications for general anesthesia

There are special situations when a CS with general anesthesia should be performed for medical and life-saving reasons. This includes cases requiring emergency surgical intervention, when a threatening condition is observed in both the fetus and the mother. Also, general anesthesia for CS is used if the woman refuses other forms of anesthesia or it is impossible to administer them (this is typical for severe obesity, abnormalities or damage to the spine, etc.).

If the patient has contraindications to regional anesthesia such as bleeding, then she is also recommended to undergo a CS with a general type of anesthesia. General anesthesia is used less and less during cesarean delivery, because it has many undesirable side effects, but still, in case of emergency intervention, its benefits are invaluable.

Endotracheal anesthesia

One of the types of general anesthesia is endotracheal anesthesia. It is carried out by introducing a special tube into the tracheal cavity, which communicates with a device for artificial pulmonary ventilation. Through this tube, the woman is given inhalational anesthetic and oxygen. As a result, the pregnant woman falls into a long medicated sleep, during which she does not feel any pain. Endotracheal types of anesthesia make it possible to carefully control the duration of the patient's stay in anesthetic sleep, so the likelihood of waking up during the operation is absolutely excluded.

Quite often, such anesthesia is used in conjunction with intravenous anesthesia during cesarean section in order to increase the duration of anesthetic sleep and to control the respiratory activity of the pregnant woman.

Pros and cons

An undoubted advantage of endotracheal anesthesia for cesarean section is the speed of induction into anesthesia, which requires only a few minutes. When it is necessary to perform an emergency operation, such speed is very important to save the baby’s life. In addition, endotracheal anesthesia works 100%, putting the patient to sleep and ensuring complete absence of painful sensitivity.

In comparison with intravenous general anesthesia, endotracheal anesthesia is tolerated much easier by women, it is easily controlled by an anesthesiologist and can be extended at any time. In addition, the patient’s heart rate and pressure indicators remain normal with the selected endotracheal anesthesia.

Among the disadvantages of such anesthesia are the risk of depression of the infant’s respiratory functions and the likelihood of reflux of contents from the gastric cavity into the trachea. In addition, during the insertion of the tube there is a real risk of a sharp response increase in pressure in the woman in labor. An undoubted disadvantage of general and endotracheal anesthesia is the impossibility of contact between the mother and the newborn after its removal. And the medications that are administered to the mother also penetrate into the baby’s bloodstream.

When indicated, contraindications

Endotracheal anesthesia is indicated if an emergency intervention is planned, if there are contraindications to other types of anesthesia, if the condition of the fetus and the well-being of the mother in labor worsen, as well as with a technically complex and long-term surgical intervention, including large volumes of manipulation by the surgeon.

Epidural anesthesia

Epidural anesthesia is considered a popular type of anesthesia, which is increasingly used today for CS. Such anesthesia refers to local or regional types of anesthesia. Epidural anesthesia is used during planned CS, because the effect occurs after 20-25 minutes from the moment the drug is administered.

Epidural anesthesia is performed by introducing an anesthetic medication into the spinal epidural space in order to eliminate the sensitivity of the radicular nerve processes included in it. To do this, a needle is inserted between the dura mater and the wall of the spinal canal, through which a thin catheter passes, delivering the anesthetic directly into the epidural space.

The needle is then removed and the catheter is left in place until the end of the surgical procedure so that additional anesthetic can be administered if necessary.

Advantages and disadvantages

It’s difficult to say which anesthesia is better, but epidural anesthesia has its undoubted advantages:

Excellent for performing a planned caesarean section, because compared to other types of anesthesia it has minimal effect on the baby;
During the operation, the patient remains conscious all the time, and when the baby is removed from the uterus, the mother will be able to see him immediately. The baby can even be put to the mother's breast;
Epidural analgesia causes a slight decrease in blood pressure, which makes it possible to administer a larger volume of drugs by infusion. This provides excellent prevention of significant blood loss during the intervention;
Epidural pain relief significantly reduces the duration of the postoperative rehabilitation period;
Since the catheter remains in the spine throughout the entire operation, the anesthesiologist can administer an additional dose of anesthetic at any time if such a need arises.

But despite all the advantages of an epidural, you should not choose it without familiarizing yourself with the disadvantages of the method. There are few of them, but they are very significant. For example, performing epidural anesthesia requires an anesthesiologist to be highly qualified, which not all specialists in this profile possess. In addition, such anesthesia is not suitable for emergency cases when the question of saving the life of a child or woman in labor is at stake.

The anesthetic drug still affects the child, even though it is administered epidurally. Since such anesthesia causes a drop in blood pressure, until the drug begins to fully act, the child will experience some intrauterine hypoxia. Sometimes during anesthesia, anesthesiologists make the wrong puncture, then the drug may not work fully, anesthetizing only half of the body.

If the doctor is insufficiently qualified, complications such as toxic poisoning of the patient or infection may occur after epidural anesthesia. Among the dangerous complications, experts identify convulsive seizures, cessation of respiratory activity and death.

When to do it and when it’s contraindicated

A CS with epidural injection of anesthetic is indicated if a woman suffers from gestosis or renal pathologies, diabetes or hypertension and heart defects. Also, an “epidural” is indicated, if necessary, as a gentle method of pain relief during surgical procedures.

If there is no anesthesiologist in the maternity hospital who knows the practice of epidural anesthesia, or there is no appropriate equipment and materials, then such anesthesia is contraindicated. Women do not carry it out even if they wish. In addition, if there is fetal hypoxia and bleeding in the woman in labor, low blood pressure or bleeding disorders, general infection in the blood or inflammatory and infectious lesions at the puncture site, then epidural anesthesia is also not performed.

If a pregnant woman has a pathology of the spine, various types of curvature or damage, then this type of pain relief is also not used. An epidural is not used if there is hypersensitivity to the injected drug, etc. After the procedure, complications such as headaches and back pain, urinary disorders, etc. may occur.

Spinal anesthesia

A good alternative to epidural pain relief is spinal anesthesia, but in contrast, spinal insertion places the needle slightly deeper, piercing the thick spinal lining. Therefore, such anesthesia is also called spinal anesthesia. Usually the puncture is performed between the 3-4 or 2-3 lumbar vertebrae. The drug is injected directly into the spinal mass.

If epidural anesthesia is performed in a sitting position, then a spinal injection is administered when the woman in labor lies on her side, with her legs pulled as far as possible towards her stomach.

Pros and cons

The positive characteristics of spinal anesthesia are all the advantages of an epidural, but in addition to them there are also specific advantages:

Spinal and epidural anesthesia also have the same disadvantages, but only after spinal anesthesia complications often arise, such as back pain and migraines, which go away on their own over time.

Indications, contraindications

The indications for spinal injection of anesthetic are similar to epidural anesthesia. An additional indication is the need for emergency intervention when general anesthesia is contraindicated. In addition, spinal anesthesia is used when a pregnant woman does not have problems with her health or pregnancy, since such anesthesia lasts a limited amount of time, depriving the doctor of the opportunity to perform additional surgical procedures.

Carrying out a cesarean section under local spinal anesthesia is not always possible and has specific contraindications. Spinal anesthesia is not used if the patient has lost a lot of blood or suffers from severe dehydration, has bleeding disorders and allergic reactions to the use of medications. Such anesthesia should not be used for high ICP and fetal hypoxia, nervous system disorders and exacerbation of herpes virus infection, heart problems and inflammatory infections. It is also strictly forbidden to take anticoagulants that thin the blood before surgery.

Which anesthesia is better to choose?

For a caesarean section, which anesthesia is preferable? The question is complex, because there are no absolutely safe types of pain relief. Each method has specific contraindications and the risk of adverse reactions. General methods of pain management are characterized by difficult tolerability of medications and difficult rehabilitation. As for minimal harm, this can only be said about the spinal type of anesthesia, which is practically safe for the woman in labor and the newborn.

Over the past half century, Caesarean section has become a widely used delivery procedure, in which the baby is delivered through an incision in the uterus. This became possible thanks to the use of antibiotics, which significantly reduced the death rate statistics.

Indications for planned caesarean section

The presence of mechanical obstacles that prevent natural delivery;
Discrepancy between the width of the mother’s pelvis and the size of the fetus;
Transverse position or breech presentation of the fetus;
Multiple pregnancy;
Diseases of the kidneys and cardiovascular system in women;
There is a threatening rupture of the uterus, for example, there is a scar on it from a previous birth;
The appearance of genital herpes in the third semester of pregnancy;
A woman's desire.

Types of anesthesia for caesarean section

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for independent treatment. Be sure to consult your doctor!

Caesarean section is a surgical procedure in which the newborn is removed through an incision in the abdominal wall and uterus. Thanks to this procedure, thousands of children are born every year, so the question of how this operation is performed worries many future parents. At the same time, one of the most important points that you should think about on the eve of childbirth is the type of pain relief.

So, which anesthesia is better for a caesarean section? From the article you can learn basic information about the most commonly used types of pain relief during this operation, their main advantages and disadvantages.

How is surgery performed?

Before you find out which anesthesia is better for a caesarean section, you should say a few words about the essence of this surgical intervention.

During a caesarean section, the newborn is not delivered naturally (through the birth canal), but is removed through a small incision that the surgeon makes in the wall of the uterus. In modern maternity hospitals, the incision is made in the lower abdomen, making the scar after the operation almost invisible. This method of obstetrics is very common and widely used in practice: in some European countries, for example in Germany, up to 40% of babies are born this way.

There are two types of surgical intervention: planned and emergency. The first is done if there is a risk of developing any complications during natural childbirth that threaten the life and health of the mother and baby. Indications for this operation include the mother’s pelvis being too narrow, the threat of hypoxia, labor that began prematurely, multiple pregnancies, etc. Naturally, planned surgical intervention is the more preferable option, since there is time to prepare the woman in labor for the upcoming operation.

Emergency surgery is performed if any dangerous complications arise during natural childbirth. At the same time, emergency surgery in most cases is carried out using general anesthesia, one of the main advantages of which is the rapid onset of the anesthetic effect: this is very important, because sometimes during complicated childbirth the minutes count.

Naturally, such a surgical operation is unthinkable without the use of anesthesia, otherwise the patient may not survive the painful shock.

What types of pain relief are used for caesarean section?

There are two main types of anesthesia that can be used during a cesarean section: regional and The first completely deprives of sensation only the lower half of the body, while with general the patient’s consciousness is completely turned off and all her muscles relax. At the same time, the choice of an adequate and most suitable method of anesthesia can only be made by a doctor, taking into account the characteristics of the pregnancy, the state of the mother’s health and many other factors.

Types of anesthesia for caesarean section:

general anesthesia;
spinal;
epidural.

The main advantages and disadvantages of each of them are described below.

When can the choice be made in favor of general anesthesia?

The essence of general anesthesia is that, thanks to a complex of drugs that are injected into the venous bloodstream or through a tube inserted into the respiratory tract, the patient completely loses consciousness and ceases to experience pain. It is important to note that during general anesthesia, muscle relaxation is observed, which makes it possible to create comfortable working conditions for the obstetrician surgeon.

This type of pain relief for women undergoing cesarean section is relatively rarely chosen. The need for general anesthesia may arise in the following cases:

the presence of contraindications to other existing methods of pain relief;
the woman in labor is obese;
the fetus is diagnosed with hypoxia;
woman’s refusal to use other types of pain relief;
abnormal position of the fetus in the uterus, prolapse of the umbilical cord and other obstetric emergencies.

Nowadays, caesarean section is used if there is a need to perform it for emergency reasons, and surgical intervention needs to be started urgently in order to save the lives of the woman in labor and the child. This is due to the fact that general anesthesia has a number of significant disadvantages.

Disadvantages of general anesthesia

What anesthesia is better for caesarean section? Before answering this question, let's talk about its disadvantages. Doctors try to avoid this type of anesthesia during cesarean section, since anesthesia can cause many more complications compared to other pain management methods. Among the most common it is worth highlighting:

hypoxia of the woman in labor, which is caused by the fact that during anesthesia the volume of the lungs decreases and the body’s need for oxygen increases;
there is a high risk of aspiration, that is, gastric contents entering the respiratory tract: if the anesthesiologist does not diagnose this condition in a timely manner, the consequences can be disastrous;
Many women in labor experience increased blood pressure during general anesthesia.

The anesthetic can lead to disruption of the newborn's respiratory activity, as well as have a depressing effect on his nervous system due to the penetration of painkillers through the placenta. The latter is especially dangerous if general anesthesia is used for premature birth. However, there is no need to be too afraid: modern medications can reduce the risk of developing negative consequences for the child to a minimum, and the newborn also receives special medications that relieve the effects of general anesthesia.

Thus, which anesthesia is best for a caesarean section is up to you and your doctor to decide, but remember that general anesthesia is far from the best way to relieve pain from the operation, and you should resort to it only if there are no other options for one reason or another. remains. For example, if a woman in labor has an unstable psyche or suffers from any psychiatric illnesses, the operation can only be performed under general anesthesia, because there is a high risk that the woman will not be able to remain calm during the operation and will interfere with the surgeon’s actions.

Much more often in practice, epidural and spinal anesthesia are used, that is, regional methods of pain relief - these types are much safer, and also allow the woman to be in a state of clear consciousness during childbirth. This is important not only because she has the opportunity to immediately hold the newborn in her arms. During a cesarean section, the obstetrician and anesthesiologist can maintain constant contact with the patient, which makes it easier to identify possible complications.

Epidural anesthesia procedure

Before answering the question of what is the best anesthesia for a caesarean section, it is worth finding out what it is. This is a procedure in which an anesthetic is injected into the epidural space of the spine in the lumbar region. After anesthesia produced by this method, the woman in labor remains conscious during the operation, but does not experience any pain.

With a caesarean section, it allows the woman to take an active part in the birth process: communicate with the medical staff or the spouse present in the room, immediately pick up the newborn and put him to the breast. In this case, the woman in labor does not feel pain, although some note slight discomfort during the operation.

True, there is one very important nuance. It is psychologically difficult for many women to decide to stay in the operating room; they are afraid that during a caesarean section they will be conscious and not feel half of their body. Often, women in labor insist on general anesthesia. It is advisable to discuss your fears with your doctor and anesthesiologist, who will tell you in detail how the pain relief procedure will proceed.

Advantages of epidural anesthesia

Among the main advantages of epidural anesthesia are the following:

Stable functioning of the cardiovascular system, absence of pressure surges.
Maintaining the ability to move.
There is no injury to the upper respiratory tract and there is no risk of aspiration.
Long duration of anesthetic effect. If necessary, anesthesia can be extended for any period of time, which is very important if, after a cesarean section, it is necessary to perform any other operations, for example,
The woman recovers from anesthesia quite quickly, the postoperative recovery period is shortened: just 24 hours after the operation, many patients can get up and move independently.
The baby can be picked up and placed to the breast immediately after the operation.
It is possible to reduce pain after childbirth by injecting painkillers into the epidural space.

Disadvantages of epidural anesthesia

Despite all its benefits, the consequences of epidural anesthesia for caesarean section can be disappointing. Every expectant mother in labor should know this:

If the anesthetic is administered by an insufficiently experienced specialist, there is a high risk of the drug entering the bloodstream. At the same time, convulsions develop, blood pressure drops sharply and consciousness is depressed. The result may be the death of the mother in labor or irreversible damage to the nervous system.
In about 17% of cases, the anesthesia fails to block certain nerves, causing the woman in labor to experience discomfort during a C-section. Therefore, before starting surgery, it is necessary to check sensitivity using special neurological tests, such as pin pricks. If the anesthetic does not work properly, repeated administration of the drug is required.
If the medication gets under the arachnoid membrane of the spinal cord due to improper insertion of the catheter, a spinal block may occur, which often results in failure of the respiratory system. To avoid this, a small dose of the drug is administered first: the surgical team only needs to wait two minutes to determine whether the procedure was performed correctly.

Unfortunately, epidural anesthesia for cesarean section is quite complex, and its success often depends on the experience and skills of the specialist. Tactile detection of the epidural space is rather vague, while a reliable marker is the emergence of cerebrospinal fluid to the surface. Therefore, it is important to choose a doctor you trust and carefully study reviews about the work of the maternity hospital where your baby will be born.

Spinal anesthesia

At first it seemed like a real salvation, because it not only made it possible to make the process of giving birth to a child completely painless, but also gave women the opportunity not to lose clarity of thinking and perception at the moment of the birth of the long-awaited baby. However, due to numerous contraindications and the likelihood of a number of negative consequences listed above, epidural anesthesia is gradually giving the palm to spinal anesthesia. Many claim that this is the best anesthesia for caesarean section.

Spinal anesthesia involves the injection of an anesthetic into the lumbar region of the back. The drug enters the subarachnoid space of the spinal cord. Moreover, the effect of both types of anesthesia is similar: some time after the injection, the woman in labor ceases to feel the lower half of her body, and the doctor can begin the necessary surgical procedures.

Pros of spinal anesthesia

What anesthesia is best for caesarean section? It is quite difficult to answer this question, since everything is individual. But we can highlight the main advantages of spinal anesthesia:

No toxic effect. If the anesthetic accidentally gets into the bloodstream, there are practically no reactions from the heart or nervous system, and there is no risk to the child.
After the operation, the body recovers quite quickly.
High-quality pain relief: during the operation, the woman in labor does not experience pain.
Spinal anesthesia additionally relaxes the muscles, which makes the doctor's work easier.
The operation can begin a few minutes after the drug is administered, so the intervention takes less time.
Spinal anesthesia is much easier to perform than epidural. In addition, the anesthesiologist uses a much thinner needle to administer the drug, thereby minimizing the risk of spinal cord injury or erroneous administration of the anesthetic.
Many doctors recognize spinal anesthesia as the most advanced option for cesarean section anesthesia.

for caesarean section: contraindications and main disadvantages

Unfortunately, spinal anesthesia also has some disadvantages:

The drug is effective for two hours, so this type of anesthesia is not suitable if it is necessary to perform any additional manipulations, and if complications arise during the operation, additional anesthesia may be required.
Spinal anesthesia is not possible if the patient has certain types of spinal injuries.
Due to the rapid onset of anesthesia, blood pressure may decrease.
If the instruments used to administer the drugs were not thoroughly disinfected, various infectious complications, such as meningitis, may occur.
After surgery, many women in labor experience severe headaches that can last for several days or even weeks.
As a result of incorrect insertion of the catheter, the nerve center called the cauda equina can be damaged. This may cause the innervation of the sacrum and lumbar region to be disrupted.
Spinal anesthesia is not possible for some forms of spinal deformity.
Spinal anesthesia is not possible for premature placental abruption and some other obstetric conditions.

Despite the disadvantages listed above, spinal anesthesia is considered one of the best and safest techniques for pain relief during caesarean section.

Pain relief for caesarean section: reviews

What anesthesia is better for caesarean section? Feedback about how women feel during this or that type of anesthesia will help us find the answer to this question.

Young mothers note that the process of emerging from general anesthesia is quite unpleasant: there is a feeling of clouding of consciousness, nausea, headaches and muscle pain. In addition, there is no opportunity to hold the baby in your arms immediately after birth. There is another negative consequence of general anesthesia: often after it the child experiences respiratory depression.

What anesthesia is better for caesarean section? Reviews about epidural anesthesia are mostly positive. Mothers in labor note that after the procedure there are no unpleasant sensations, and the baby can be immediately put to the breast. True, as reviews indicate, there are often unpleasant sensations in the area where the drug is administered, and in the first few hours after a cesarean section, when the anesthetic is removed from the body, the lower half of the body trembles violently. However, just a day after the operation, it is possible to get on your feet, move independently and care for the newborn.

Spinal anesthesia has generally received positive results. Patients note that they did not experience pain during the operation. However, in some cases, women suffer from headaches and abdominal discomfort for several weeks.

How to choose anesthesia?

So which anesthesia is best for a caesarean section? This article aims to familiarize expectant mothers with what types of anesthesia are used to relieve pain during a caesarean section. But remember, in no case should you be guided by the above information when choosing anesthesia! Only a doctor who has all the data on the health status of the mother in labor can choose the right type of pain relief. Of course, the patient’s wishes cannot be ignored. Therefore, before deciding which anesthesia is best for a caesarean section, you should weigh all the pros and cons of one method or another, and consult with a surgeon and anesthesiologist.

In order for the chosen anesthesia to be successful, it is necessary to follow all the recommendations of specialists who will advise how to eat on the eve of the operation, when to get up after a caesarean section and what to do to ensure that the body recovers as quickly as possible.

Spinal anesthesia for caesarean section is common in modern maternity hospitals. This method of pain relief during surgery has several advantages. The selection of anesthesia is carried out by a doctor. The specialist examines the progress of pregnancy and the woman’s medical history. 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 painful shock, doctors use a variety of painkillers.

During a caesarean section, three types of anesthesia are used: deep anesthesia, spinal or subarachnoid anesthesia, and epidural anesthesia. The choice depends on the reasons for the caesarean section.

Many clinics use anesthesia. This method allows you to adjust the surgical process. The specialist can also choose a drug suitable for long-term sleep. But European maternity hospitals rarely use anesthesia. Preference is given to spinal or epidural anesthesia. The difference between these methods lies in the features of administering the drug into the spinal canal.

For epidural anesthesia, a catheter is used. It is installed in the intervertebral space. The active substance is introduced through it. Spinal anesthesia is performed using a thin, long needle. It is inserted into the spinal space. An anesthetic drug is injected through a needle.

All of the above techniques have positive and negative sides. To choose the right method of pain relief, you need to consult a doctor. He will explain what problems may arise after surgery. The specialist will also 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 complete preservation of consciousness. Spinal anesthesia applies only to the lower torso. The brain and thoracic region work as usual. This method of performing a cesarean section gives the 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 brain function. Spinal anesthesia eliminates the post-anesthesia state.

Many women are afraid of a cesarean section due to psychological conditions. Fear of the unknown during surgery is accompanied by the development of stress. For this reason, pain relief using this method avoids additional inconvenience. The child is immediately shown to his mother. The 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 sensitivity in the abdominal area, lower extremities and pelvis. After surgery is completed, the new mother can perform her usual activities without additional inconvenience. After normal anesthesia, recovery is required within two days. Consciousness returns fully after this period. Spinal anesthesia eliminates this stage of postoperative recovery. On the day of surgery, the patient can perform a number of permitted actions.

The positive side is the speed at which the drug begins to act. The first signs of the drug's effect appear within five minutes. In ten minutes the woman can be operated on. This effect is used for emergency caesarean section. If natural childbirth is not accompanied by dilatation of the uterus, doctors administer an anesthetic and perform a Caesarean section on the woman.

What else do you need to know?

Any prescription of a 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 administration. The active substance blocks the functioning of the nerve endings of the spinal column. Due to this, an analgesic effect is achieved. Absorption of the drug into the bloodstream occurs slowly. Since the fetus receives all harmful and beneficial substances through the placenta, anesthesia does not cause harm.

When anesthesia is used, part of the substance is absorbed into the bloodstream. The first day after a cesarean section, the baby may be lethargic and have difficulty latching on to the breast.

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

Negative points

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

pain 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 cesarean section, you may experience soreness in the puncture area. Often the pain radiates to the lumbococcygeal region. Unpleasant sensations are relieved with analgesic medications. After a few days, the pain disappears.

In some patients, partial numbness of the lower extremities is detected. The problem occurs suddenly and also quickly goes away on its own. Numbness in the legs may occur for several months after a cesarean section. In the first days after surgery, this problem is more pronounced. If sensation in your legs does not return the next day after surgery, you should inform your doctor. The specialist will conduct a medical examination and identify the cause of this complication.

A common problem is migraine headache. The pain affects the temporal and parietal areas. Blurred vision and tinnitus may occur. A specialist cannot always completely eliminate such pain. Some women experience pain throughout their lives due to temperature changes or changes in weather conditions. You should be aware that anesthesia can cause more complex pathology. Many patients who have undergone anesthesia subsequently suffer from long-term migraines.

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

The main problem for many women in labor is hypotension. The pathology is characterized by a sharp decrease in blood pressure. The problem occurs due to interruption of the nerve impulse. Hypotension disappears after 3–4 months. But for some mothers it remains for life. Critical conditions should be avoided through additional therapy. Taking vitamin-mineral complexes helps well against this disease.

Risks of the proposed method

Spinal pain relief has several risks. Before performing a cesarean section, the specialist must carefully examine the patient's medical history. The presence of any pathologies may affect the course of surgery.

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

The experience of the medical worker administering spinal anesthesia is also important. Not every doctor can administer the drug correctly. If the worker has little experience or practice, the effect of anesthesia may not occur or may not last long. Rarely does swelling develop due to improper administration of the drug. To avoid such a pathology, you need to consult your doctor and ask the opinion of patients who have undergone spinal anesthesia.

Rarely does an expectant mother experience an allergic reaction. A few days before the cesarean 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 research. Caesarean section is also performed 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 permitted for caesarean sections. This method of pain relief has several contraindications. The following prohibitions exist:

long-term course of late toxicosis;
pathological increase in intracranial pressure;
problems with blood clotting;
heart ailments;
hypoxic injury of a child.

It is prohibited to use spinal anesthesia during long-term 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. Minor bleeding occurs during the operation. If the patient requires a caesarean section, anesthesia is used.

A pathological increase in intracranial pressure precludes the use of many medications. Spinal analgesia affects spinal pressure. A sudden drop in pressure causes the heart rate to stop. The choice of anesthesia method is made by an anesthesiologist.

The main contraindication is reduced blood clotting. During surgery, tissues and many small vessels are injured. If you use spinal anesthesia, there is an increased risk of large blood loss. Surgery is also excluded if you are constantly taking anticoagulant drugs. These medications thin the blood. 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 dysfunction preclude the use of many medications. 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 certain 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 blood fluid;
withdrawal of concomitant therapy;
monitoring the condition of the fetus.

A woman needs to donate blood from a vein for testing. Specialists study blood for quantitative and qualitative composition. An increased level of leukocytes and lymphocytes indicates the development of latent inflammation. A low red blood cell count can also become 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. The use of anticoagulants should be avoided. This will avoid the development of bleeding during cesarean section. Hormonal therapy is also cancelled. If a woman is undergoing chronic therapy, she should inform the doctor.

It is not only the woman who is subject to scrutiny. The condition of the child is also studied. Ultrasound diagnostics is used for this purpose. It is necessary to determine whether the fetus is developing correctly and whether it has any problems. The work of the child’s heart is also studied. For this study, a special device is attached to 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 the method of anesthesia selected.

Characteristics of the procedure

Spinal anesthesia is not difficult. To administer the drug, the woman must lie on one side. The legs are bent at the knees and pressed towards the chest. In the upper part of the lumbar spine, the skin is treated with an antiseptic solution.

The anesthetic substance is drawn into a special syringe with a long thin needle. The puncture area is marked with a special napkin. The needle is inserted between the vertebrae. There is little resistance as it passes through the wall of the spinal cord. It indicates the selection of the correct site. The medicinal substance is injected into the cavity. The needle is removed.

From this moment on, you need to monitor the patient's condition. The first sign of the onset of action of the substance is a feeling of fullness in the puncture area. Next, the woman notices loss of sensation in one leg, then the second limb is taken away. After this, my stomach goes numb. A caesarean section can be performed.

Pregnancy is a wonderful period in a woman's life. Childbirth does not always go as planned. If a patient is scheduled for a cesarean section, do not be alarmed. In this case, spinal anesthesia is often used for caesarean section.

In certain cases, childbirth cannot proceed 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 caesarean section is better is very relevant.

If the operation is planned, the doctor discusses the choice of pain relief with the patient, offering his options. If you had to perform an emergency caesarean procedure, the doctor makes his own decision. Today, general (including endotracheal) anesthesia and regional (spinal, epidural, spino-epidural) anesthesia are used.

Modern surgeons and anesthesiologists do not welcome, but are still sometimes forced to perform intravenous general anesthesia during a 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 administration 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;
umbilical cord prolapse;
placenta accreta;
previous spinal surgery;
refusal of the woman in labor to receive regional anesthesia;
emergency caesarean section.

If these indications exist, a cesarean section is performed under intravenous general anesthesia.

Advantages

Despite the fact that most clinics today have abandoned the use of intravenous general anesthesia when performing a cesarean section, it still has a number of advantages. These include:

complete pain relief;
maximum muscle relaxation, which is very convenient for the surgeon;
rapid action of anesthetics, which allows the operation to be performed instantly, when every minute counts;
does not affect cardiac activity;
does not provoke a drop in pressure;
the doctor constantly monitors 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 these benefits, intravenous general anesthesia is rarely offered to women undergoing cesarean 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;
breathing problems in the baby;
a depressing effect on the nervous system of the fetus, which will be expressed in its excessive lethargy, lethargy, drowsiness, whereas at such a moment it is required to be active;
aspiration - release of stomach contents into the trachea;
hypoxia in a woman in labor;
When connected to a ventilator (artificial pulmonary ventilation), a woman in labor may experience increased blood pressure and increased heart rate.

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

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

This is interesting! Scientists from the USA have found that the state of a person under anesthesia is more equivalent to a coma than to sleep.

Endotracheal general anesthesia

General anesthesia also includes endotracheal anesthesia, which is used in case of cesarean section. The pain relief drug enters the body's cells through a tube that the anesthesiologist inserts into the trachea. Most doctors, if delivery surgery cannot be avoided, choose this particular technique. Its indications are exactly the same as those of general intravenous anesthesia, but there are many more advantages.

Pros

Doctors prefer endotracheal general anesthesia when performing a cesarean section for the following reasons:

the drug penetrates the placenta more slowly than when administered intravenously, 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 supplied in more precise quantities, and the dosage of the drug 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 penetrate into the lungs.

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

Cons

The bodies of the mother and the baby may react differently to medications 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 to the point of fainting;
weak consciousness;
injuries to 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 conditions of delivery, when they are responsible for the life of the mother and child. Therefore, recently regional types of anesthesia for caesarean section have been used, 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 rays were used as a kind of anesthesia.

Spinal anesthesia

Local (regional) spinal anesthesia during cesarean section ensures 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 when the anesthetic is administered. With an epidural, she sits, whereas here she will be asked to lie in the fetal position, with her legs tucked under her stomach as much as possible.

Indications

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

an emergency situation, and general anesthesia is contraindicated;
performed epidural anesthesia at the beginning, which must be completed by cesarean section;
gestosis;
heart disease;
arterial hypertension;
diabetes mellitus;
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 cesarean section:

the patient’s refusal of this type of anesthesia;
lack of necessary equipment or qualified specialist;
large blood loss;
disorders associated with the circulatory system;
any infections, inflammation, sepsis, ;
allergy to the administered drug;
heart problems;
high intracranial pressure;
diseases of the central nervous system;
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 mother and child can expect the most serious complications after spinal anesthesia used during a cesarean section. That is why, if an operation is performed, a woman should discuss all her health problems with her attending physician and decide whether this type of anesthesia is suitable for her or not. It has its advantages and disadvantages.

Pros

The most common question asked by women in labor preparing for a cesarean 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. Advantages 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 exposure to drugs on the fetus: with epidural anesthesia, the volume of the administered substance is much larger;
the ability to remain conscious throughout childbirth;
due to lower blood pressure, doctors can control blood loss;
passes faster and much easier than after general anesthesia;
using a thinner needle than with epidural anesthesia, so that pain at the puncture site is subsequently eliminated;
no risk of spinal cord damage;
lower price.

When it comes to the question of which anesthesia to choose (epidural or spinal) for a caesarean section, price does not at all determine 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, no type of anesthesia is without its drawbacks.

Cons

In rare cases, the effects of spinal anesthesia during a caesarean section can be as dangerous as those under general anesthesia. So the woman in labor should know in advance about all the disadvantages of this type of pain relief, which include:

High professionalism of the anesthesiologist is required;
complications include infection, meningitis, toxic poisoning, convulsions, respiratory arrest, spinal cord damage, 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 can still have an effect on the child;
limited (no more than 2 hours) duration of action of the anesthetic drug:
a sharp drop in blood pressure in a woman in labor, which is accompanied by attacks of nausea and dizziness.

So, if you are about to have a caesarean section, it is worth weighing 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, back in 1846, Thomas Morton (American dentist) performed an operation under anesthesia. This date is now considered Anesthesiologist's Day all over the world.

Epidural anesthesia

Recently, epidural anesthesia is increasingly used for planned caesarean sections, which does not require the same precision 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 performed and how it differs from spinal anesthesia. After all, each of them will have its own consequences for your body and for the health of the baby.

It begins to act 20, not 5 minutes after administration of the medicine.
The anesthetic is injected into the epidural space of the spine rather than into the cerebrospinal fluid.
The needle is much thicker.
It is inserted between the spinal canal and the dura mater of the brain, and not between the vertebrae.
The needle insertion is much more superficial than with spinal anesthesia.
A catheter is inserted and remains in the spine throughout the operation. During spinal anesthesia there is no such tube.
More expensive, since the volume of the drug that is introduced into the body is much larger.

As for the side effects that a woman may 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 people feel only a slight tingling sensation when the needle is inserted, while others experience convulsions if a nerve is accidentally touched. So here it all depends on the level of pain threshold and individual characteristics.

Indications

if at the beginning of natural childbirth it was already performed, but surgical intervention was urgently required;
serious illnesses in the woman in labor: gestosis, high blood pressure, kidney or liver problems, severe myopia;
premature pregnancy;
contraindications for general anesthesia;
excessive labor, cervical pathologies;
the desire of the woman in labor.

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

Contraindications

When preparing for a caesarean section, you must take into account all the contraindications to epidural anesthesia, of which there are many. Otherwise, serious complications and irreversible consequences may occur. This method cannot be used in the following cases:

presence of problems with blood clotting;
bleeding;
increased intracranial pressure;
tattooing 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 collapse;
diseases of the spine and spinal cord;

During the day, the Clexane injection used for the treatment and prevention of thrombosis is often contraindicated for women in labor. If for some reason these contraindications were not taken into account, consequences of epidural anesthesia for caesarean section may occur, 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 the benefits of epidural anesthesia for caesarean section:

complete pain relief;
not such a strong effect on the fetus as with general anesthesia;
the 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 throughout the 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 anesthesia does not have.

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

Flaws

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

erroneous administration of the drug inside a 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 a negative one) on the fetus;
If the caesarean section is not completed within 2 hours due to unforeseen complications, the epidural anesthesia will have to be extended.

The most serious disadvantage of this type of anesthesia used during cesarean section is the consequences after epidural anesthesia, which are sometimes too dangerous and irreversible. It is almost impossible to predict them.

Consequences

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

Complications for the mother during childbirth:

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

Postpartum consequences for women:

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;
breathing problems, motor skills;
disorientation;
difficulty sucking;

If spouses who are about to become parents are faced with the problem of which anesthesia is best for a caesarean section, it should only be resolved together with their attending physician. 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 spino-epidural (epidural-spinal) anesthesia.

Interesting fact. One chance in 200 thousand is the probability of a woman in labor dying from anesthesia.

Spinoepidural 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 neutralize their disadvantages. It became widespread specifically during surgical delivery not so long ago, but has proven itself simply excellent. An increasing number of doctors are leaning towards this method of pain relief.

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