Endotracheal anesthesia for cesarean section on the mother with blood disease

This is an automatically translated article.

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 the mother with blood disease is a technique of general anesthesia with intubation. The aim is to control breathing during surgery and to perform postoperative resuscitation.

1. Indication for the mother with blood disease

Thalassemia Congenital Anemia Autoimmune hemolytic anemia Coagulopathy associated with thrombocytopenia or drug-induced thrombocytopenia Congenital coagulopathy: Von Willebrand Coagulation factor deficiency Pathology Acquired coagulation: Disseminated intravascular coagulation syndrome (DIC) Sickle cell disease Hypercoagulopathy due to deficiency of Antithrombin III, Protein C, Protein S... Note that surgical endotracheal anesthesia is not performed perform cesarean section on a mother with blood disease when the patient does not agree, the medical facility does not have enough anesthesia and resuscitation facilities, or the technician is not proficient in professional techniques.

2. Preparation for endotracheal anesthesia for cesarean section

2.1. The person performing the technique Nursing doctor specializing in anesthesiology and resuscitation. 2.2.Preparation of equipment for surgical endotracheal anesthesia Anesthesia machine system with breathing Hand-held oxygen source System of vital functions monitoring machine (ECG monitoring, arterial blood pressure measurement, arterial blood gas SpO2, EtCO2, respiratory rate measurement, body temperature measurement)

Defibrillator Aspirator Laryngoscope Laryngoscope Endotracheal tube Suction tube Mask Balloon Oropharyngeal Cannula Soft Magill Mandrin Pliers. Medicines: Lidocaine 10% spray, Salbutamol spray. Means of prevention in case of difficult intubation: Cook tube, laryngeal mask, flexible bronchoscope, tracheostomy kit, mouth opener... 2.3. Prepare patient for cesarean section Pre-anesthesia visit to detect and prevent risks Explain to patient Evaluate difficult intubation Give patient sedation the night before surgery (if necessary).

3. Procedure for performing endotracheal anesthesia for cesarean section in a mother with blood disease

3.1 General procedure The patient is in supine position, breathing 100% oxygen 3-6 liters/min, starting at least 5 minutes before induction of anesthesia. Install a Monitor Set up an effective transmission line. Perform pre-anesthesia (if necessary)

3.2 Procedure for induction of anesthesia Sleeping pills: intravenous anesthetics (propofol, etomidate, ketamine...), volatile anesthetics (sevoflurane, Isoflurane..). Analgesics: fentanyl, sufentanil, or remifentanil, morphine Muscle relaxants (if necessary): succinylcholine, rocuronium, vecuronium 3.3 Intubation technique Condition for oral intubation is that the patient is in deep sleep and has a sufficient level of sleep. muscle relaxants. The technician opens the patient's mouth, puts his hand under the neck so that the neck is straight, inserts the laryngoscope to the right of the mouth, then moves the tongue to the left, pushes the light deep in, coordinates with the right hand to press the cricoid cartilage to find the larynx. glottis and glottis. Perform rapid induction of anesthesia and Sellick maneuver in case of full stomach (press the cricoid cartilage 20-30 kg as soon as the patient loses consciousness until the intubation is complete). Continue to intubate the endotracheal tube gently through the glottis, stop when the endotracheal tube passes through the vocal cords from 2-3 cm, then gently withdraw the laryngoscope, inflate the endotracheal balloon. Check the correct position of the endotracheal tube (based on bilateral auscultation and on EtCO2 results) Secure the endotracheal tube with adhesive tape. Insert the cannula into the mouth to prevent the patient from biting the tube (if necessary). In the case of difficult intubation, a difficult intubation procedure should be applied. 3.4 Anesthesia Maintenance Techniques Maintain anesthesia with intravenous or volatile anesthetics, analgesics and muscle relaxants (if necessary). Control the patient's breathing with a machine or hand squeeze. Monitor the depth of anesthesia (monitor BIS/Entropy, heart rate, blood pressure, sweat, tears...). Monitor vital signs. Be careful with the endotracheal tube in the wrong position, flexion, obstruction.

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). Postoperatively, the patient can breathe spontaneously. Breathing rate is within normal limits. The pulse and blood pressure are stable. Body temperature is over 35 degrees Celsius. There are no complications of anesthesia and surgery.

5. Complications when performing endotracheal anesthesia technique for cesarean section in a mother with blood disease

Gastroesophageal reflux into airway (with digestive juices in the mouth and in the airways): aspirate the fluid, lay the head low and tilt to one side, quickly insert the endotracheal tube and aspirate the fluid, monitor and take precautions Pulmonary infections Hemodynamic disturbances: increased and decreased blood pressure, cardiac arrhythmia. .. Respiratory complications: retraction, folding or the endotracheal tube is pushed deep into one lung, the respiratory system is open, the oxygen source is exhausted... Complications after extubation: respiratory failure, sore throat hoarseness , laryngotracheal-bronchospasm, upper respiratory tract infection, laryngotracheal stenosis...

Special attention should be paid to mothers with blood diseases:
Pregnant women having cesarean section with bleeding or clotting disorders: need blood transfusion or blood products. Pay attention to signs of splenomegaly, ventricular hypertrophy, heart failure. Pay attention to parameters MCV, low Hb and prolonged TQ, TCK. Prevention of thromboembolism and the risk of allergies. Prevention of blood transfusion complications Prevention of serious blood clotting disorders that can be fatal to pregnant women. 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.

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