Observation 1 patient after anesthesia. Assessment of the patient's condition
Before neurosurgery the patient's condition needs to be assessed. Some parameters of the condition assessment are common for all patients who are to undergo surgery or other surgical interventions, but certain groups of patients require a special or more detailed examination. This chapter will not consider the general principles of preoperative preparation of patients, but only the features specific to neurosurgical patients. This article is about elective neurosurgical operations. The same principles apply to emergency operations, although time constraints lead to certain changes. Features of preparing patients for some specific types of intervention will be discussed in the following articles on the MedUniver website.
Tasks of preoperative assessment of the patient's condition
Preoperative examination performs five overlapping functions:
Determining the urgency of surgical treatment.
Timely assessment of the patient's condition and preoperative drug therapy, which may affect the technique of anesthesia and surgery.
Identification of patients whose condition can be improved by the treatment of comorbidities before surgery.
Identification of patients requiring special postoperative care
Informing patients about the benefits and risks of the chosen anesthetic technique, pain management and postoperative care. Although these principles are more relevant to the organization of elective operations, they apply to urgent and emergency operations as well.
Peculiarities organizations preoperative examination depends on many factors specific to each clinic. However, there are general principles:
Timeliness of preoperative assessment of the patient's condition. There should be sufficient time between the pre-operative examination and the date of the scheduled operation to complete the examinations and evaluate the results, so that all issues can be resolved in time. But at the same time, if the time interval between the examination and the operation is too long, neurological symptoms may progress.
Multidisciplinary approach in preoperative assessment of the patient's condition. Preoperative preparation includes not only medical aspects, but also issues that are usually solved by nursing staff, such as social adaptation, fears and concerns about the disease and the upcoming operation. The surgeon and the anesthesiologist may have different requirements for the organization of the process, so they must participate in the preparation.
Some clinics may employ specially trained nurses who perform the duties of both a nurse and a surgeon and anesthesiologist, however, more often, the duties of an anesthesiologist are performed to some extent by residents.
Documentation in preoperative patient assessment. Medical records should be clear and unambiguous. The system should function in such a way that it is always possible to early identify patients with significant overlapping diseases or disorders identified during the study. There should be agreed recommendations on thromboembolism prevention, the use of appropriate investigation methods, and the continuation (or discontinuation) of certain drugs (aspirin, clopidogrell, NSAIDs, warfarin).
History and examination. Regardless of who conducts the preoperative examination, it is necessary to identify key parameters that are especially important in neuroanesthetic practice.
The patient's airway. Undoubtedly, it is important to note the history of difficulties during intubation. Patients with degenerative diseases of the lower spine may also have disease in the cervical spine, which may cause limited movement or be associated with myelopathic symptoms on movement. Postponed surgery on the cervical spine can lead to fixation of the cervical spine in a position that precludes direct laryngoscopy.
Have a large number patients with a brain injury, there is a concomitant injury to the cervical spine.
In many patients with acromegaly obstructive sleep apnea (OSA) is noted, some may also have sleep apnea of central origin. Treatment of acromegaly does not necessarily reverse the anatomical changes predisposing to OSA.
The patient's respiratory system. Patients with myelopathy of the upper cervical segments associated with internal or external compression of the spinal cord may have significant breathing difficulties. They can be difficult to recognize due to physical activity limitations caused by neurological deficits.
In patients with damage to the bulbar structures associated with their neurological disease (tumors of the cerebellopontine angle, multiple sclerosis, syringomyelia/syringobulbia) or depression of consciousness, there is a risk of aspiration, which can often be prevented with careful examination and careful history taking.
Cardiovascular system of the patient. Hypertension is quite common in neurosurgical patients. Most often, this is essential arterial hypertension, but sometimes it is associated with the actual neurosurgical disease or with its therapy, for example, with an acute increase in ICP, acromegaly, hypo- or hyperthyroidism; prescribing corticosteroid therapy.
Development of arterial hypertension in the perioperative period is a risk factor for the occurrence of bleeding after craniotomy, therefore, if time permits, it is necessary to adjust blood pressure. Neurosurgical emergencies such as intracranial hematoma, TBI, SAH, and spinal cord injury can lead to serious cardiovascular events. These issues will be discussed separately in the following chapters.
Patient's nervous system. Before anesthesia, a thorough assessment of the patient's neurological status should be carried out, which is necessary mainly for the postoperative period. It is also necessary to assess the mental state of the patient. If the patient has impaired consciousness, the details of his history should be clarified with relatives, friends, or the attending physician.
Symptoms increased intracranial pressure include headache when changing body position (postural headache), worse in the morning, coughing or sneezing, accompanied by vomiting. Other symptoms include papilledema, unilateral or bilateral mydriasis, III or IV cranial nerve palsy, absence of brainstem reflexes (or, if severe, systemic hypertension, bradycardia, and Cushing's triad respiratory failure). You also need to evaluate the Glasgow Coma Scale.
The frequency and type of seizures should be described along with other known precipitating factors.
Endocrine system of the patient. Many patients suffer from type 2 diabetes. It is necessary to control glycemia, especially in patients who have recently been prescribed corticosteroids.
Patient's blood system. It is necessary to find out whether the patient or the family has cases of hematomas with minor injuries, prolonged bleeding, and other characteristic signs of clotting disorders. Liver disease should be considered as a risk factor for coagulopathy. You should also identify risk factors for venous thromboembolism and try to eliminate them.
On an outpatient basis, before releasing the patient after surgery and anesthesia, the doctor must make sure that the adequacy of his reactions and behavior is restored. This should be based on assessment of the general condition of the patient and his psychophysiological functions. Immediately after anesthesia, the patient is placed in a horizontal position in the ward or room for postoperative observation. After regaining consciousness ask questions about well-being. In the presence of lethargy, weakness, nausea, the patient should lie down for a longer time. For each patient, it is necessary to find out how he orients himself in space and time by asking him a few simple questions. Quite often, special tests are used for these purposes, for example testBidway, - disappearance of postoperative drowsiness and restoration of orientation (E. Garry et al., 1977). The patient's responses are evaluated on a 5-point system:
4 points - the patient does not respond to the verbal command and pain stimulation;
3 points - the patient responds to pain stimulation, but does not make contact;
2 points - the patient responds to a verbal command and responds to pain stimulation, but does not orient himself in space and time;
1 point - the patient responds to all forms of stimulation, is well oriented in time and space, but feels drowsy;
0 points - the patient is well oriented in space and time, there is no drowsiness.
After the above phenomena disappear, check the recovery motor coordination. It is necessary to make sure that there is no nystagmus, check the stability in the Romberg position, conduct a finger-nasal test, note the absence of ataxia when walking with closed and open eyes. The patient must be fully oriented and stable in relation to the functions of the vital organs, not experience nausea, the urge to vomit, be able to move around, drink and urinate.
They also determine the clarity and speed of thinking, attention and orientation in the environment. To do this, you can use a special Bourdon test(crossing out a given letter in 10 lines of regular book text) or Garatz test(writing 5-7 three-digit numbers, and each subsequent one must begin with the last digit of the previous one). Correct or with an insignificant number of errors and a fairly quick performance of these tests indicates a complete restoration of attention and orientation.
Pain is eliminated by the appointment of analgesics per os. After that, the patient must be escorted home and on the first day he must be under control. The patient should also be instructed to: contact the clinic in case of complications; stop drinking alcohol, as well as driving a car and using any technical devices during the first 24 hours, since it is impossible to accurately predict the full recovery of all body functions. An appropriate entry must be made in the individual outpatient record - the main medical and legal document.
In stationary conditions, the possibility of monitoring and monitoring the patient after undergoing intubation anesthesia is more favorable. Directly from the operating room after awakening and extubation of the patient, it is advisable to transfer to special awakening wards, organized in the conditions of the intensive care unit and anesthesiology, where he stays for 2-3 hours under the dynamic supervision of specialists until complete recovery from anesthesia with a guarantee of restoration of vital parameters of homeostasis of the body and elimination of possible complications associated with general anesthesia. If necessary (after extensive, prolonged or traumatic surgical interventions in the maxillofacial region) with a likely threat of early complications from the vital functions of the body or their instability, it is advisable to transfer the patient from the operating room (in agreement with the operating surgeon and anesthesiologist) to intensive care wards with the use of technical means of monitoring on the 1st–3rd day (sometimes in such cases, extubation is performed only in intensive care wards after the patient's condition has been fully compensated). Subsequently, for further specialized treatment, the patient is transferred to the department of maxillofacial surgery, where, along with the main treatment, they also prevent the development of post-anesthetic complications (alkaline-oil inhalations, exercise therapy, control analyzes of body homeostasis parameters are prescribed).
After undergoing neuroleptanalgesia or short-term intravenous anesthesia, the patient in a stable compensated state can be transferred from the operating room immediately to the wards of the maxillofacial surgery department under the supervision of the attending physicians and the medical staff on duty.
The increased desire of anesthesiologists to predict outcomes and better plan intensive care is inextricably linked to the development and improvement of methods for evaluating the treatment process.
Modern prediction of treatment outcomes is based on the use of "scoring systems for assessing the severity of the condition." Predicting the treatment of intensive care patients includes the APACHE II and III scales, TISS, the scale for assessing the severity of injury, the Glasgow coma scale. Predicting the results of surgical treatment is based on the use of systems of "degrees of operational and anesthetic risk" and "indices for predicting perioperative morbidity". These "forecasting systems" are designed to provide both unified rules for an objective assessment of the treatment process and contribute to the creation of therapy standards.
A limiting factor in the widespread use of "point systems" in the practice of an anesthesiologist is the inability to predict treatment in one patient. It is also important that these systems provide more legal protection for the anesthesiologist and have little effect on the choice of therapy method:
1. The APACHE scale allows predicting the outcome of treatment for certain categories of patients, but not for an individual patient.
2. Widespread use of the Goldman risk index is impractical due to interhospital differences in treatment tactics. The anesthesiologist can only assess the absolute risk of an isolated treatment exposure.
3. The system for assessing the intensity of therapeutic actions (TISS) allows you to determine the severity of the disease and assess the possibility of providing the necessary amount of medical care to a particular patient, but a comparison of estimates using this system is not possible due to the specificity of medical care in various ICUs.
4. The proposed classifications of the risk levels of anesthesia have little effect on the choice of the method of anesthesia. The severity of the patient's condition at the time of surgery, the volume, and the urgency of the surgical intervention are assessed, as a rule, separately.
In practice, the most important thing is to choose the optimal method of intensive care for one patient supervised by an anesthesiologist. The main tool used in the selection of the method of therapy, as well as in the analysis of treatment, is the assessment of the severity of the patient's condition. But the purposes of the “assessment” are different. When making a disease prognosis, the goal is to identify factors that determine the severity of the patient's condition and risk factors that can complicate the course of the disease. When choosing a treatment program, the goal is to choose the method of therapy. This difference forms different ways of assessing the severity of the patient's condition. And it is on the basis of this difference that methods for an objective assessment of the severity of the patient's condition can be formed, capable of determining the choice of methods of intensive care.
The principle of identifying and eliminating the cause of the disease underlies the development and improvement of modern methods of therapy. The nosological approach, which is actively used in therapeutic tactics, can also be applied in assessing the patient's condition.
According to the principle of "causation", the occurrence of illness or even death occurs due to the body's inability to resist or at least compensate for damaging mechanisms. Any damaging effect leads to the emergence of compensatory reactions of the body, the focus of which is to preserve the functional and morphological structure of the body. Functional shifts that occur in response to damage can be fixed, leading to morphological changes, which can later act as a damaging factor, leading to the involvement of new compensatory mechanisms. In the process of life, a person is constantly exposed to adverse factors and, in the absence of protective, compensatory mechanisms that arise in response to damage, is doomed to death.
Based on the foregoing, it can be assumed that the assessment of the patient's condition should take into account the following points:
1. Damage assessment
2. Evaluation of compensation
3. Evaluation of compensation mechanisms
“Injury assessment” means the identification of an acute or chronic damage to the structure of the body. Analysis of information should include all organs and systems of the body. The decisive influence on the prognosis of treatment is exerted by the amount of damage, the time during which the injury occurred, the “aggressiveness of the injury” (damage to vital organs, massive bleeding, etc.).
"Assessment of compensation" allows you to evaluate both the compensatory capabilities of a particular person and the strength of the damaging effect. Evaluation options include two parameters: compensated and not compensated.
"Assessment of compensation mechanisms" allows you to identify both the quantitative and qualitative nature of the mechanisms involved, and the tension of compensatory reserves.
This scheme for assessing the patient allows a more qualitative assessment of the patient's condition; guide the doctor on the choice of the optimal method of treatment for this particular person; predict outcomes and better plan intensive care.
A distinctive feature of the preoperative examination is the need to choose the method of anesthesia, planning the option of anesthetic protection. The difficulty for the doctor is the fact that the assessment of the mechanisms of functioning of the body systems at the time of surgery does not allow the anesthetist to identify objective data that determine the choice of the method of anesthesia, the choice of an adequate level of pain protection. At the same time, the traditional idea of anesthetic aid as “protecting the patient from operational stress” does not take into account the patient’s condition at the time of surgery, the direction of his protective and adaptive reactions, and, as a result, does not fully reflect the adequacy of the chosen method of anesthetic aid. The creation of uniform rules for an objective assessment of the severity of the patient, which could determine the choice of the method of anesthesia, becomes one of the priority tasks in improving the methods of the intraoperative stage of treatment.
The use of the proposed scheme for assessing the severity of the patient's condition provides an opportunity for the doctor to better prepare for the conduct of anesthesia. A thorough assessment of the volume of the previous injury, the safety of the body's compensatory reserves at the time of surgery allows the anesthesiologist to choose the best methods of intensive care for the supervised patient. The availability of information about the type and volume of the planned operation, the features of the surgical technique, the likelihood of complications in the course of surgical treatment provides an opportunity to better form an action plan, to determine the range of tasks for intensive care of the surgical stage of treatment. And the main task of the intensive care phase of the operation should be to maintain and / or correct the functions of body systems through a preliminary assessment of the mechanisms of their functioning at the time of surgery.
When choosing a method of anesthesia, the anesthesiologist must take into account that the operation is the elimination or correction of the resulting violation of the structure of the organ or organ systems by deliberately causing additional damage to the body. A distinctive feature of surgical intervention is that the compensatory reactions that occur in response to surgical trauma are often unable to respond promptly and adequately to surgical invasion, and thus surgical intervention, the purpose of which is to treat the patient, is itself a powerful damaging factor. in the absence of sufficient protection, leading to aggravation of the disease or death.
The use of means for assessing and monitoring the vital functions of the body, the possibility of urgently attracting additional methods of intensive therapy allows the anesthetist to timely correct the resulting homeostasis disorders at any stage of the surgical intervention, but does not affect the mechanisms of protection of the body from surgical trauma. In the absence of sufficient pain protection, the use of the most modern methods of Intensive Therapy "distorts" the results of the operation and negatively affects the process of further treatment. The effectiveness of anesthetic (pain) protection becomes one of the main factors that determines the prognosis of treatment.
Anesthesia becomes an active part of the therapy of the surgical stage of treatment, a part of intensive care. Based on this provision, the anesthesiologist gets the opportunity to plan the option of anesthesia, taking into account the required level of protection from surgical trauma. Formulate the tasks of anesthesia for each individual patient, from minimal sedation to total analgesia, based on the main task - the prevention and / or correction of the depletion of the factors of the body's pain system in response to damage.
Modern anesthetic management should be regarded as a complex of therapeutic measures of the surgical stage of treatment, part of the patient's treatment program, where "pain protection" is an active part of therapeutic actions.
This view of the anesthetic manual will make it possible to set other requirements for the quality and improvement of anesthesia methods, and, no less important, for the improvement of methods for assessing the treatment process.
Introduction.
CARE OF THE PATIENT AFTER ANESTHESIA
anesthesia(other Greek Να′ρκωσις - numbness, numbness; synonyms: general anesthesia, general anesthesia) - an artificially induced reversible state of inhibition of the central nervous system, in which loss of consciousness, sleep, amnesia, pain relief, relaxation of skeletal muscles and loss of control occur over some reflexes. All this occurs with the introduction of one or more general anesthetics, the optimal dose and combination of which is selected by the anesthesiologist, taking into account the individual characteristics of a particular patient and depending on the type of medical procedure.
From the moment the patient enters the ward from the operating room, the postoperative period begins, which lasts until discharge from the hospital. During this period, the nurse should be especially attentive. An experienced, observant nurse is the closest assistant to the doctor; the success of treatment often depends on her. In the postoperative period, everything should be aimed at restoring the patient's physiological functions, at the normal healing of the surgical wound, and at preventing possible complications.
Depending on the general condition of the person operated on, the type of anesthesia, and the characteristics of the operation, the ward nurse ensures the desired position of the patient in bed (raises the foot or head end of the functional bed; if the bed is ordinary, then takes care of the headrest, cushion under the legs, etc.).
The room where the patient comes from the operating room must be ventilated. Bright light in the room is unacceptable. The bed should be placed in such a way that it is possible to approach the patient from any side. Each patient receives special permission from the doctor to change the regimen: at different times they are allowed to sit down, get up.
Basically, after non-cavitary operations of moderate severity, with good health, the patient can get up near the bed the next day. The sister should follow the first rise of the patient from the bed, not allow him to leave the ward on his own.
Care and monitoring of patients after local anesthesia
It should be borne in mind that some patients are hypersensitive to novocaine, and therefore they may experience general disorders after surgery under local anesthesia: weakness, drop in blood pressure, tachycardia, vomiting, cyanosis.
Cyanosis is the most important sign of hypoxia, but its absence does not at all mean that the patient does not have hypoxia.
Only careful monitoring of the patient's condition allows you to recognize the beginning of hypoxia in time. If oxygen starvation is accompanied by carbon dioxide retention (and this happens very often), then the signs of hypoxia change. Even with significant oxygen starvation, blood pressure may remain high and the skin pink.
Cyanosis- bluish coloration of the skin, mucous membranes and nails - appears when every 100 ml of blood contains more than 5 g% of reduced (i.e., not associated with oxygen) hemoglobin. Cyanosis is best identified by the color of the ear, lips, nails, and the color of the blood itself. The content of reduced hemoglobin can be different. In anemic patients, who have only 5 g% of hemoglobin, cyanosis does not occur in the most severe hypoxia. On the contrary, in full-blooded patients, cyanosis appears at the slightest lack of oxygen. Cyanosis can be not only due to a lack of oxygen in the lungs, but also due to acute cardiac weakness, in particular cardiac arrest. If cyanosis occurs, immediately check the pulse and listen to the heart sounds.
arterial pulse- one of the main indicators of the cardiovascular system. Examine in places where the arteries are located superficially and are accessible to direct palpation.
More often, the pulse is examined in adults on the radial artery. For diagnostic purposes, the pulse is also determined on the temporal, femoral, brachial, popliteal, posterior tibial and other arteries. To calculate the pulse, you can use automatic blood pressure monitors with pulse readings.
The pulse is best determined in the morning, before meals. The ward should be calm and not talk while counting the pulse.
With an increase in body temperature by 1 ° C, the pulse increases in adults by 8–10 beats per minute.
The voltage of the pulse depends on the value of arterial pressure and is determined by the force that must be applied until the pulse disappears. At normal pressure, the artery is compressed with a moderate effort, therefore, the pulse of moderate (satisfactory) tension is normal. At high pressure, the artery is compressed by strong pressure - such a pulse is called tense. It is important not to make a mistake, since the artery itself may be sclerosed. In this case, it is necessary to measure the pressure and verify the assumption that has arisen.
If the artery is sclerosed or the pulse is poorly felt, measure the pulse on the carotid artery: feel the groove between the larynx and the lateral muscles with your fingers and press lightly.
At low pressure, the artery is squeezed easily, the voltage pulse is called soft (non-stressed).
An empty, relaxed pulse is called a small filiform. Thermometry. As a rule, thermometry is carried out 2 times a day - in the morning on an empty stomach (between 6 and 8 am) and in the evening (between 16-18 hours) before the last meal. During these hours, you can judge the maximum and minimum temperatures. If you need a more accurate idea of the daily temperature, you can measure it every 2–3 hours. The duration of temperature measurement with a maximum thermometer is at least 10 minutes.
During thermometry, the patient should lie down or sit.
Places for measuring body temperature:
Armpits;
Oral cavity (under the tongue);
Inguinal folds (in children);
Rectum (debilitated patients).
Care and supervision of patients after general anesthesia
The post-anesthetic period is no less important stage than anesthesia itself. Most of the possible complications after anesthesia can be prevented by proper patient care and meticulous implementation of doctor's prescriptions. A very important stage of the post-anesthetic period is the transportation of the patient from the operating room to the ward. It is safer and better for the patient if he is taken from the operating room to the ward on the bed. Repeated shifting from the table to the gurney, etc., can cause respiratory failure, cardiac activity, vomiting, and unnecessary pain.
After anesthesia, the patient is placed in a warm bed on his back with his head turned or on his side (to prevent the retraction of the tongue) for 4-5 hours without a pillow, covered with heating pads. The patient should not be awakened.
Immediately after the operation, it is advisable to put a rubber ice pack on the area of the surgical wound for 2 hours. The application of gravity and cold to the operated area leads to squeezing and narrowing of small blood vessels and prevents the accumulation of blood in the tissues of the surgical wound. Cold soothes pain, prevents a number of complications, lowers metabolic processes, making it easier for tissues to tolerate circulatory insufficiency caused by the operation. Until the patient wakes up and regains consciousness, the nurse should be around him relentlessly, observe the general condition, appearance, blood pressure, pulse, and breathing.
Transportation of the patient from the operating room. Delivery of the patient from the operating room to the postoperative ward is carried out under the guidance of an anesthesiologist or nurse of the postoperative ward. Care must be taken not to cause additional trauma, not to displace the applied bandage, not to break the plaster cast. From the operating table, the patient is transferred to a stretcher and transported to the postoperative ward on it. A gurney with a stretcher is placed with its head end at a right angle to the foot end of the bed. The patient is picked up and transferred to the bed. You can put the patient in another position: the foot end of the stretcher is placed at the head end of the bed and the patient is transferred to the bed.
Preparing the room and bed. Currently, after particularly complex operations, under general anesthesia, patients are placed in the intensive care unit for 2–4 days. In the future, depending on the condition, they are transferred to the postoperative or general ward. The ward for postoperative patients should not be large (maximum for 2-3 people). The ward should have a centralized supply of oxygen and the entire set of tools, apparatus and medications for resuscitation.
Typically, functional beds are used to give the patient a comfortable position. The bed is covered with clean linen, an oilcloth is placed under the sheet. Before laying the patient, the bed is warmed with heating pads.
Care of the patient in the event of vomiting after anesthesia
In the first 2-3 hours after anesthesia, the patient is not allowed to drink or eat.
Help with nausea and vomiting
Vomiting is a complex reflex act that leads to the eruption of the contents of the stomach and intestines through the mouth. In most cases, it is a protective reaction of the body, aimed at removing toxic or irritating substances from it.
If the patient is vomiting:
1. Seat the patient, cover his chest with a towel or oilcloth, bring a clean tray, basin or bucket to his mouth, you can use vomit bags.
2. Remove dentures.
3. If the patient is weak or unable to sit, position the patient so that his head is lower than his body. Turn his head to one side so that the patient does not choke on vomit, and bring a tray or basin to the corner of his mouth. You can also put a towel, folded several times, or a diaper to protect the pillow and linen from soiling.
4. During vomiting, be near the patient. Lay the unconscious patient on their side, not on their back! It is necessary to introduce a mouth expander into his mouth so that during vomiting with closed lips there is no aspiration of vomit. After vomiting, immediately remove the dishes with vomit from the room so that a specific smell does not remain in the room. Let the patient rinse with warm water and wipe his mouth. In very weakened patients, each time after vomiting, it is necessary to wipe the mouth with a gauze cloth moistened with water or one of the disinfecting solutions (boric acid solution, a clear solution of potassium permanganate, 2% sodium bicarbonate solution, etc. .).
Vomiting "coffee grounds" indicates stomach bleeding.
Anesthesia(pain relief) is a series of procedures designed to relieve the patient from pain. Anesthesia is performed by an anesthesiologist, but in some cases by a surgeon or dentist. The type of anesthesia is chosen, first of all, depending on the type of operation (diagnostic procedure), the patient's health status and existing diseases.
Epidural anesthesia
Epidural anesthesia consists in the supply of anesthetic into the epidural space using a thin polyethylene catheter with a diameter of approximately 1 mm. Epidural and spinal anesthesia belong to the group of so-called. central blocks. This is a very effective technique that provides a deep and long blockade without the use of general anesthesia. Epidural anesthesia is also one of the most effective forms of pain management, including postoperative pain.
Epidural anesthesia is the most popular pain relief during childbirth. Its advantage is that the woman in labor does not feel painful contractions, so she can relax, calm down and concentrate on childbirth, and with a caesarean section, the woman remains conscious and the pain after childbirth decreases.
Indications for the use of epidural anesthesia
surgery on the lower extremities, especially if they are very painful, eg hip replacement, knee surgery;
operations on blood vessels - coronary artery bypass surgery of the femoral vessels, aortic aneurysms. Allows for long-term treatment of postoperative pain, rapid re-operation, if the first failed, fights thrombosis;
operations to remove varicose veins of the lower extremities;
abdominal surgery - usually together with mild general anesthesia;
serious operations on the chest (thoracosurgery, i.e. lung operations, cardiac surgery);
urological operations, especially in the lower urinary tract;
the fight against postoperative pain;
Today, epidural anesthesia is the most advanced and effective way to deal with pain after surgery or during childbirth.
Complications and contraindications for epidural anesthesia
Every anesthesia carries a risk of complications. Proper preparation of the patient and the experience of the anesthesiologist will help to avoid them.
Contraindications for epidural anesthesia:
lack of patient consent;
infection at the puncture site - microorganisms can enter the cerebrospinal fluid;
blood clotting disorders;
infection of the body;
some neurological diseases;
violations of the water and electrolyte balance of the body;
unstabilized arterial hypertension;
severe congenital heart defects;
unstabilized coronary heart disease;
serious changes in the vertebrae in the lumbar region.
Side effects of epidural anesthesia:
lowering blood pressure is a fairly common complication, but appropriate monitoring of the patient's condition allows it to be avoided; a decrease in blood pressure is most felt by patients in whom it is elevated;
back pain at the injection site; pass within 2-3 days;
"Patchwork" anesthesia - some areas of the skin may remain unpained; in this case, the patient is given another dose of anesthetic or a strong analgesic, sometimes general anesthesia is used;
arrhythmia, including bradycardia;
nausea, vomiting;
delay and complication of urination;
point headache - appears due to a puncture of the hard shell and leakage of cerebrospinal fluid into the epidural space;
hematoma in the area of anesthetic injection, with concomitant neurological disorders - in practice, a complication is very rare, but serious;
inflammation of the brain and spinal membranes.
Point headache should only occur with spinal anesthesia, because only then does the anesthetist intentionally pierce the dura to inject the anesthetic into the subdural space behind the dura. With proper performance of epidural anesthesia, headaches do not appear, since the hard shell remains intact. Point headache occurs with different frequency, more often in young people and women in labor; appears within 24-48 hours after anesthesia and lasts 2-3 days, after which it disappears on its own. The cause of a point headache is the use of thick puncture needles - the thinner the needle, the less likely this complication is. Analgesics are used to treat acupressure headaches. The patient must lie down. In some cases, an epidural patch is performed using the patient's own blood. Some anesthesiologists recommend lying quietly for several hours after surgery and anesthesia.
