Endotracheal anesthesia for cesarean section on a mother with multiple trauma

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The article is expertly consulted by an Anesthesiologist, anesthesiologist, anesthesiologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.
Endotracheal anesthesia for cesarean section on pregnant women with multiple trauma is a general anesthetic technique when the mother refuses, does not cooperate with the anesthetic method, in urgent emergencies or when under anesthesia. failure.

1.Definition of endotracheal anesthesia for cesarean section in pregnant women with multiple trauma

Endotracheal anesthesia for cesarean section on pregnant women with multiple trauma is a technique of general anesthesia, with intubation for the purposes of:
Control breathing during surgery Resuscitation after surgery Mrs. Pregnant women with multiple trauma include common cases such as:
Head trauma, pelvic fracture, blunt abdominal trauma, chest trauma. Shocked blood loss due to traffic accident. Blood loss from a fall or domestic violence leads to shock. Trauma causes obstetric complications such as uterine rupture, placental abruption, amniotic fluid embolism. Note: Do not perform endotracheal anesthesia for cesarean section surgery on pregnant women with multiple injuries, when the patient disagrees, the medical facility does not have enough anesthesia and resuscitation facilities or the technician does not perform the procedure. professional technical proficiency.

2.Preparation for endotracheal anesthesia for caesarean section

The person performing the technique
- Doctor
- Anesthesiology specialist nurse
Prepare equipment for endotracheal anesthesia
Anesthesia machine system with breathing oxygen source Squeeze oxygen source Life function monitor system ( monitor electrocardiogram, measure arterial blood pressure, arterial blood gases SpO2, EtCO2, measure breathing rate, measure body temperature) Defibrillator Aspirator Laryngoscope Laryngoscope Endotracheal tube Suction tube Mask Balloon oropharyngeal , Magill pliers, soft mandrin. Medicines: Lidocaine 10% spray, Salbutamol spray.

Means of prevention in case of difficult intubation: Cook tube, laryngeal mask, flexible bronchoscope, tracheostomy kit, mouth opening pliers... Prepare patient before cesarean section
Pre-anesthesia visit to detect and prevent risk of aspiration, cervical spine injury, airway obstruction Assess injury scale Explain to patient Evaluate difficult intubation Administer evening sedation the day before surgery (if necessary).

3. Procedure for performing endotracheal anesthesia for cesarean section on a mother with multiple trauma

3.1 General procedures The patient is in supine position, breathing 100% oxygen 3-6 liters/min, at least 5 minutes before induction of anesthesia. Install a monitor Set up an infusion line (blood line and central venous pressure monitoring in pregnant women with hemorrhagic shock) Pre-anesthetic slow intravenous analgesia for pregnant women: low dose Fentanyl 3.2 Procedure Induction of anesthesia Intravenous anesthetics should preferably be with Ketamine at a dose of 1-1.5mg/kg or Etomidate. The hypnotic drug with a relative contraindication in this case is Propofol. Painkillers often used during cesarean section on pregnant women with multiple trauma: fentanyl, sufentanil, morphine... Can be used in combination with muscle relaxants (if necessary): succinylcholine, rocuronium, vecuronium. .. Conditions to perform endotracheal intubation for the patient are: the pregnant woman has slept deeply and has enough muscle relaxation.

3.3 Oral intubation technique Open the patient's mouth, place one hand under the neck to straighten the neck (except for women with cervical spine injury), insert the laryngoscope to the right of the mouth and then slide the tongue to the left , push the lamp deep in, coordinate with the right hand to press the cricoid cartilage to find the epiglottis and glottis. Initiate rapid induction of anesthesia Perform the Sellick maneuver in case the mother's stomach is full Continue intubating the endotracheal tube gently through the glottis, stopping when the balloon of the endotracheal tube passes through the vocal cords from 2 -3 cm and then gently withdraw the laryngoscope. Endotracheal balloon pump. Check the correct position of the endotracheal tube (based on auscultation with both lungs and based on EtCO2 results) Fix the endotracheal tube with adhesive tape. Place the cannula in the mouth to prevent the patient from biting the tube (if necessary). 3.4 Procedures for maintaining anesthesia Maintain anesthesia with an intravenous or volatile anesthetic such as sevorane or Isoflurane. Use of pain relievers and muscle relaxants Control the mother's breathing with a machine or hand squeeze. Monitor the depth of anesthesia techniques by monitoring heart rate, blood pressure, sweat, tears, MAC, BIS, Entropy (if any)... Monitor vital signs: heart rate, blood pressure , SpO2, EtCO2, body temperature. It is necessary to prevent the endotracheal tube from being pushed to the wrong position, folded, or blocked.

4. When can the endotracheal tube be extubated?

Pregnant women are awake, can follow orders, muscle relaxants are completely neutralized. Raise the patient's head for more than 5 seconds, the TOF index > 0.9 (if any). Postoperative patient had spontaneous breathing, respiratory rate within normal limits, stable pulse and blood pressure, body temperature above 35 degrees Celsius. There were no complications of anesthesia and surgery.

5. Related adverse events

Reflux of gastric juice into the airways (with digestive juices in the mouth and in the airways): aspirate the fluid, lie down with the head low and tilt to one side Hemodynamic disorders: increase or decrease in blood pressure, heart rhythm disturbances due to intubation, mistakenly placed in the stomach, due to laryngotracheal-bronchospasm, trauma when intubating... Respiratory complications: endotracheal intubation into one lung, systemic regurgitation respiratory failure, lack of oxygen... Complications after extubation: respiratory failure, sore throat hoarseness, laryngotracheal-bronchospasm, upper respiratory tract infection, laryngotracheal stenosis... Systemic Vinmec International General Hospital, with its comprehensive expertise, facilities and professional service quality, has successfully performed surgical endotracheal anesthesia in cesarean section.
Endotracheal anesthesia in cesarean section at Vinmec has many advantages:
High success rate ≥ 95%, complication rate ≤ 5%, ensuring safety of 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. Customers who need advice and support on endotracheal anesthesia for cesarean section at Vinmec International Hospital, please contact Hotlines of hospitals for advice, support or register online HERE .