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The number of caesarean sections has increased over the past two decades, especially in developed countries. As a result, cesarean section anesthesia has become increasingly more of a challenge, but this has given obstetric anesthesiologists the opportunity to contribute more. Although regional anesthesia has become an important step forward, cesarean section anesthesia still plays an irreplaceable role in certain deliveries.
1. Anesthesia in caesarean section
Obstetric anesthesiologists are faced with the unique situation of cesarean section anesthesia, where the anesthesiologist must care for both mother and fetus. A team-based approach based on maternal characteristics and comorbidities is important to ensure optimal outcomes while ensuring that labor is a safe experience for the “surviving” mother. shallow".
The rate of cesarean section has an increasing trend over the past two decades not only in developed countries but also in developing countries. The reason for this increase is due to many factors; of which, one reason may be due to the increase in elective caesarean section due to preference among patients and obstetricians. Accompanying this, the increase in urgent emergency cesarean deliveries in pregnancy-threatening situations also requires optimal cesarean section anesthesia techniques.
Up to now, there have been many methods of anesthesia for cesarean section. In particular, the number of cesarean sections performed under regional anaesthesia was higher than that of general anaesthesia. Indeed, new techniques for regional anesthesia, such as combined epidural and continuous spinal anesthesia, offer outstanding advantages. However, cesarean section anesthesia still plays an irreplaceable role in certain deliveries. Even recently, obstetric anesthesiologists have also paid more attention to the use of supralaryngeal ventilators in cesarean section anesthesia, especially when there is difficulty in breathing in pregnant women with structural problems. The upper respiratory tract is not favorable.
In addition, maternal comorbidities such as obesity and preeclampsia are also a challenge for obstetric anesthesiologists.
Số ca phẫu thuật vô cảm phẫu thuật lấy thai ngày càng tăng
2. Indications for cesarean section anesthesia
There are many indications for general anaesthesia , for example when a woman has failed regional anesthesia, has acquired a contraindication to regional anesthesia, when the mother's condition is urgent and life-threatening to the fetus that may not be present. enough time to perform the region-sensing technique.
Previously, general anesthesia was the technique of choice for many people. However, the proportion of cesarean deliveries under general anaesthesia today has decreased significantly as local anesthetic methods show more advantages. However, when the mother has an indication for cesarean section anesthesia, this technique is still performed quickly, promoting the ability to respond quickly as well as safely for the surgery to take place more easily. .
MORE: General anesthesia in emergency cesarean section
2. Obstacles of cesarean section anesthesia
The decline in the number of cesarean deliveries under general anesthesia is due to limitations, especially when overcome by more modern and simplified methods of local anesthesia.
One of the obstacles of cesarean section anesthesia is airway problems during pregnancy. This feature will become more common than in the general population due to anatomical and physiological changes during pregnancy. Some of the anatomical changes that can affect the maternal airway include upper airway edema, breast enlargement, and excessive weight gain. Moreover, intubation in pregnant women preparing for caesarean section will be more difficult than in other subjects, especially when women have short neck, obesity, misaligned maxillary incisors and out. Therefore, the team of obstetric anesthesiologists always need to ensure the techniques and means of rescue, dealing with airway emergencies when intubation is difficult or failed.
Besides, aspiration is one of the concerns of general anesthesia in obstetric patients. Factors that increase the risk of aspiration are not fasting enough before cesarean section or fasting for too long, prolonged empty stomach will increase gastric secretion.
After labor, increased intra-abdominal pressure due to uterine compression and lower esophageal sphincter relaxation due to hormonal changes. To reduce this risk, prophylaxis against aspiration during caesarean section anesthesia by aspiration of gastric acid will be performed prior to anesthesia.
Việc gây mê mổ thai ngày càng trở thành một thách thức lớn hơn
3. Compare the role of general anesthesia with regional anesthesia
Spinal or epidural anesthesia is safer than general anesthesia. The mother can be awake when the baby is born and can hold and breastfeed the baby immediately after birth. The mother's partner may also be present during the birth. In the case of general anesthesia, the mother remains unconscious during the cesarean section and can only see her baby when she wakes up. It is also unlikely that a mate may be present.
However, compared with regional anesthesia, which can lower maternal blood pressure and may take longer to re-establish, this can be seen as an advantage of general anesthesia. Furthermore, regional anesthetics are sometimes found to be ineffective and women need to be switched to general anaesthesia.
In summary, there are more and more opportunities in anesthesia for cesarean deliveries. Although regional anesthesia may be considered superior to general anesthesia during cesarean delivery for both mother and child, cesarean section still holds the ultimate key, especially when women experience failure with regional anesthesia. Accordingly, with further experience, understanding and research, obstetric anesthesiologists will play an even greater role to optimize maternal care during cesarean section with general anesthesia.
Vinmec International General Hospital with its comprehensive level of expertise, facilities and professional service quality has successfully performed surgical anesthesia techniques in cesarean section.
Anesthesia in cesarean section at Vinmec has many advantages:
High success rate ≥ 95%, complication rate ≤ 5%, ensuring safety for cesarean section; contribute to the success of cesarean section with pathology. Modern operating room: Negative pressure operating room ensures high sterility, modern anesthesia machine system, patient monitoring machine in surgery Owns anesthesiologists with extensive experience in Obstetric Anesthesia. In addition, Vinmec Health System is also proud to be the first hospital in Vietnam to sign with the World Anesthesiology Association (WFSA) with the goal of becoming the safest hospital for surgical anesthesia in the Southeast. ASIAN. Therefore, pregnant women and their families who perform anesthesia at Vinmec can completely trust and feel secure.
Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.
References: ncbi.nlm.nih.gov, news-medical.net
