Endotracheal anesthesia for cesarean section in patients with pulmonary tuberculosis

The article is professionally consulted by an Anesthesiologist, anesthesiologist, anesthesiologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.

Pregnant women with pulmonary tuberculosis or a history of pulmonary tuberculosis may be prescribed a cesarean section by the doctor. Endotracheal anesthesia for cesarean section in patients with pulmonary tuberculosis to control the patient's breathing during and after surgery.

In cesarean section on patients with pulmonary tuberculosis, the technique of general anesthesia with intubation, also known as endotracheal anesthesia, is used to control the patient's breathing during and after surgery. art.
Endotracheal anesthesia is indicated for women with congenital tuberculosis, a history of pulmonary tuberculosis or secondary tuberculosis who have had a pleural effusion aspirated. This technique of anesthesia is also applied in cases where breathing cannot be controlled in the mother by a mask, or the woman is contraindicated or refuses to receive regional anesthesia.

To perform endotracheal anesthesia for cesarean section for pregnant women with pulmonary tuberculosis, the following means, machinery, equipment, and medications are required:
The system includes an anesthetic machine (with breathing), oxygen hand cuffs, monitors of vital functions (such as arterial blood pressure, breathing rate, temperature, ECG, EtCO2, SpO2), suction machine, defibrillator, ... Endotracheal tube sizes for placement, laryngoscope, mask, suction tube, oropharyngeal cannula, squeeze balloon, soft mandrin, Magill pliers. Salbutamol and Lidocaine 10% spray. Other means of supporting endotracheal anesthesia for cesarean section surgery in patients with pulmonary tuberculosis in case of difficult intubation: laryngeal mask, Cook tube, flexible bronchoscope, mouth opener, gas opener manage,...

Before performing surgery, patients need to be examined under anesthesia to promptly detect and prevent possible risks, as well as evaluate difficult intubation status.
Procedures for endotracheal anesthesia for cesarean section on patients with pulmonary tuberculosis include the following steps:
Step 1: Put the patient in a supine position, at least 5 minutes before induction of anesthesia, give 100% oxygen with a dosage of 3 - 6 liters/min. Install machines to monitor and set up transmission lines. If necessary, the patient can be given sedatives from the night before surgery. Step 2: Induction of anesthesia begins with intravenous injection (drugs, etomidate, propofol, ketamine, thiopental, ...), volatile anesthetics (sevoflurane...), analgesics (fentanyl, morphine, fentanyl, .. .), use a muscle relaxant if necessary (rocuronium, succinylcholine, vecuronium, ...). It is necessary to ensure conditions for endotracheal intubation during cesarean section for pregnant women with pulmonary tuberculosis (patients sleep deeply, muscles relax enough). Step 3: Carry out oral intubation as follows: (1) Open the patient's mouth, place one hand under the neck to keep the neck upright, insert the laryngoscope to the right side of the mouth, and slide the tongue. to the left side of the mouth, insert the light deeply, and at the same time use the right hand to press the cricoid cartilage to find the lid and the glottis; (2) Perform rapid induction of anesthesia and perform the Sellick maneuver when the stomach is full (as soon as the patient loses consciousness, press the cricoid cartilage 20 - 30 kg until the intubation process is complete); (3) The next step in endotracheal anaesthesia for cesarean section in patients with pulmonary tuberculosis is to gently intubate the endotracheal tube through the glottis, when the endotracheal tube is about 2 - 3 cm across the vocal cords. then stop; (4) Gently withdraw the laryngoscope; (5) Intubation of endotracheal balloon; (6) Listen to the lungs, see the EtCO2 index to check that the endotracheal tube is in place; (7) Use adhesive tape to fix the endotracheal tube. In case, if it is necessary to avoid biting the endotracheal tube, the cannula can be placed into the patient's mouth. Note, apply difficult intubation procedure for difficult intubation cases. Step 4: The next step in anesthesia, intubation, and cesarean section for pregnant women with pulmonary tuberculosis is to maintain anesthesia with anesthetics (intravenous or volatile), analgesics, muscle relaxants (if necessary). ) and control the patient's breathing with a machine or hand squeezer.

During endotracheal anesthesia for cesarean section surgery in patients with pulmonary tuberculosis, the following signs and indicators should be monitored:
Depth of anesthesia: Monitor blood pressure, heart rate, blood pressure, shedding status. sweat, tears, BIS, MAC, Entropy (if any) ... Vital signs: Monitor blood pressure, heart rate, body temperature, EtCO2, SpO2, airway pressure Monitor in case the endotracheal tube is in the wrong position, or the tube is blocked or folded. At the end of the process of endotracheal anesthesia for cesarean section for pregnant women with pulmonary tuberculosis, the following criteria should be met before extubation:
The patient is awake and can follow orders. Breathe spontaneously, breathe evenly, breathing rate is within normal limits. Blood pressure and pulse are stable. Body temperature over 35 degrees Celsius. Raise head >5 seconds, TOF index >0.9 (if any). The patient had no complications from anesthesia and surgery.

During endotracheal anaesthesia, cesarean section surgery on patients with pulmonary tuberculosis may occur some complications that need to be treated as follows:
Gastrointestinal reflux: When digestive juices are detected in the cavity. mouth and airway, immediately aspirate the fluid, place the patient in the supine position and tilt the head to the side. Rapidly intubate the endotracheal tube and remove all fluid from the airway. Monitor patients for lung infections after surgery. Hemodynamic disorders: Depending on the cause and symptoms such as arrhythmia, increase or decrease in blood pressure, ... will be treated appropriately. Difficult intubation in cesarean section anesthesia for pregnant women with pulmonary tuberculosis: Switch to difficult intubation procedure or proceed with another method of anesthesia. Misplaced endotracheal tube into the stomach: Re-intubate the endotracheal tube when misplaced with symptoms of auscultation of the lungs without alveolar murmurs, no measurement of EtCO2. Constriction of the larynx, trachea, and bronchi: Complications during endotracheal anesthesia during cesarean section in patients with pulmonary tuberculosis may cause difficulty or inability to ventilate, at this time there will be a crackling sound or a crackling sound in the lungs. mute lung. For management, it is necessary to provide adequate oxygen, and at the same time give sleeping pills and muscle relaxants, bronchodilators and corticosteroids to ensure ventilation. In case of respiratory failure, difficult intubation procedure should be applied. Trauma in endotracheal intubation: Depending on the damage such as tooth fracture, bleeding, foreign body in the airway, ... will be treated appropriately. Respiratory complications: Find and treat the cause, ensure ventilation and provide 100% oxygen during endotracheal anesthesia, cesarean section for pregnant women with pulmonary tuberculosis causing respiratory complications such as endotracheal tubes folded, retracted or pushed deep into one lung, opened or collapsed the respiratory system, the oxygen is exhausted, the effect of soda is gone, causing hypoxia. Complications after extubation: Depending on the cause, choose appropriate management when symptoms appear after extubation such as respiratory failure, hoarseness, sore throat, laryngospasm, gas trachea, bronchi, laryngotracheal and tracheal stenosis, upper respiratory tract infection.

When performing endotracheal anesthesia for cesarean section on patients with pulmonary tuberculosis, the following requirements should be kept in mind:
If the woman does not have spinal tuberculosis, she can choose spinal anesthesia or epidural anesthesia for surgery. cesarean section. Pregnant women and anesthesiologists need to wear masks and N95 masks to avoid infection. Avoid airborne germs by attaching a high-performance filter to the Y-shaped junction and the mask or endotracheal tube, the germ filter placed on the exhalation arm of the anesthetic machine. Endotracheal anesthesia for cesarean section in patients with pulmonary tuberculosis should ensure and prevent TB germs from spreading.
Endotracheal anesthesia is a routine anesthetic technique performed at Vinmec International General Hospital. Accordingly, the process of endotracheal anesthesia at Vinmec is carried out methodically and in accordance with the process standards by a team of highly qualified medical professionals and modern machinery. As a result, complications after anesthesia and surgery are always minimized to the maximum extent.
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