This is an automatically translated article.
The article is professionally consulted by an Anesthesiologist, anesthesiologist, anesthesiologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.
Endotracheal anesthesia is applied during cesarean section in women with drug-induced or autoimmune thrombocytopenia to control the patient's breathing during and after surgery.
1. Overview of endotracheal anesthesia for cesarean section in women with thrombocytopenia
In cesarean section in women with thrombocytopenia (either autoimmune disease, or drug-induced, pre-eclampsia, disseminated intravascular coagulation), the technique of general anesthesia with intubation, also known as induction endotracheal anesthesia, used to control the patient's breathing during and after surgery.
2. What should be prepared for endotracheal anesthesia for cesarean section in women with thrombocytopenia?
In order to perform endotracheal anesthesia for cesarean section in pregnant women with thrombocytopenia, the following facilities, machines, equipment and medications are required:
The system includes an anesthetic machine (with breathing), squeezer oxygen hand, monitor vital function indicators (such as arterial blood pressure, breathing rate, temperature, ECG, EtCO2, SpO2), suction machine, defibrillator, ... Endotracheal tube sizes to 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 in pregnant women with thrombocytopenia to prevent difficult intubation: laryngeal mask, Cook tube, flexible bronchoscope, mouth opener, opener set windpipe, ...
3. Procedure for endotracheal anesthesia for cesarean section in women with thrombocytopenia
Before performing surgery, patients need to be examined under anesthesia to promptly detect and prevent possible risks, as well as evaluate difficult intubation status. For women with thrombocytopenia, it is important to note the drugs used (such as aspirin, corticosteroids, NSAIDS), function and platelet count.
Procedures for endotracheal anesthesia for cesarean section in women with thrombocytopenia 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 in women with thrombocytopenia (patients sleep deeply, muscle relaxation is adequate). 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 anesthesia for cesarean section in women with thrombocytopenia 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 for cesarean section intubation in women with thrombocytopenia is to maintain anesthesia with anesthetics (intravenous or volatile), analgesics, muscle relaxants (if needed), and Control the patient's breathing with a machine or hand squeezer.
4. Monitoring during endotracheal anesthesia for cesarean section in women with thrombocytopenia
During endotracheal anesthesia for cesarean section in women with thrombocytopenia, it is necessary to monitor the following signs and indicators:
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. Monitor in case of wrong position of endotracheal tube, or blocked, folded tube. At the end of endotracheal anesthesia for cesarean section in women with thrombocytopenia, 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.
5. Management of complications after endotracheal anesthesia cesarean section in women with thrombocytopenia
During endotracheal anesthesia for cesarean section in pregnant women with thrombocytopenia, some complications may occur that need to be treated as follows:
Gastric acid 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 during cesarean section anesthesia in women with thrombocytopenia: Switch to a difficult intubation procedure or proceed to 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, bronchi: Complications in endotracheal anesthesia for cesarean section in women with thrombocytopenia may cause difficulty or inability to ventilate, at this time there will be a hissing 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 for cesarean section in women with thrombocytopenia causing respiratory complications such as endotracheal tube folding. , drop or push deep into one lung, open or collapse 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.
6. Notes during endotracheal anesthesia for cesarean section in women with thrombocytopenia
During endotracheal anesthesia for cesarean section in women with thrombocytopenia, the following requirements should be noted:
Infusion of platelets 1 to 2 hours before surgery to prevent the risk of women taking aspirin reduces platelet function and cause prolonged bleeding of the nasal mucosa, digestive tract, pharynx (platelets <15,000). Pregnant women taking cephalosporins and penicillins can reduce the activity of platelets. It is important to prevent the risk of thrombosis due to thrombocytopenia, which causes blood clots and leads to renal failure, hemolytic uremic syndrome, and nervous system symptoms similar to DIC. Prevention of increased risk of blood clotting disorders and allergies. Endotracheal anesthesia for cesarean section in women with thrombocytopenia should pay attention to the complications of the disease during and after surgery.
Vinmec International General Hospital has applied endotracheal anesthesia technique in examination, diagnosis and treatment of many diseases. The procedure of endotracheal anesthesia at Vinmec is carried out methodically and according to standard procedures by a team of highly skilled doctors and modern machinery. As a result, complications after anesthesia and surgery are always minimized to the maximum extent.
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