Anesthesia for future mother of
How not to do much harm to the kid?
Any diseases of the pregnant woman cause special alarm in the most future mother, in her family and, of course, at doctors, especially if the illness serious and demands surgical treatment. And matter not only in the operation, but also in the anesthesia accompanying it. There is a natural question: whether the anesthetizing preparations applied in modern medicine are harmless to mother and the kid?Surgical intervention in time of pregnancy can be necessary for
from - for injuries (and it is the most frequent reason), from - for sharp diseases of bodies, most often an abdominal cavity (for example, appendicitis) and an exacerbation of chronic surgical diseases.
Should not be forgotten also about stomatology. Usually people trifle of teeth externally, hiding children`s fear of a dental surgery behind this levity, but the twinge of toothache, for example, can turn back serious obstetric problems.
Pregnancy can be considered as mutual influence of three links of the closed chain is health of mother, health of the developing child and a condition of those structures which are characteristic only of pregnancy, namely a placenta and matochno - a placentary blood-groove. At any disease of the pregnant woman under blow all three links get, and problems of each of them are reflected in a condition of two others and a condition of all chain in general. In case of a surgical disease to influence of an illness on this chain also treatment influence - operation and anesthesia increases.
Main - not to do much harmanesthesia can damage
In any period of pregnancy to the developing fruit. Some anesteziologichesky preparations slow down growth of cages, break biochemical reactions of a metabolism, provoke emergence of defective cages from - for violations of processes of cell division and other. In development of the child allocate several especially dangerous periods when action of the preparations (not only anesteziologichesky - any) breaking development of a fruit (causing terratogenny effect), can lead to serious consequences, uglinesses and even death of the child. It is the period with 15 - go on 56 - y day of pre-natal development when there is laying of all bodies and systems of an organism, and with 28 - y weeks until the end of pregnancy.All preparations arriving to a fruit pass
to it through a placenta - unique body in which blood of mother and child, without mixing up, exchange with each other oxygen and carbon dioxide, nutrients and waste products. Permeability of a placenta will change with the course of pregnancy according to constantly increasing needs of the child. And that is especially important, the placenta in itself is somewhat capable to change and neutralize part of anesteziologichesky preparations. But, alas, this its ability is not boundless. Influence of some preparations can slow down process of a metabolism between mother and the child. And the violations in barrier function of a placenta arising at pregnancy complications can detain for a long time in the child`s organism anesteziologichesky preparations. At the same time, in case of long influence and accumulation of large numbers of a preparation, even rather safe medicines can damage to the kid, the fruit organism cannot neutralize and remove many medicines yet.Besides, due to the operation and action of anesteziologichesky drugs violations of a placentary and uterine blood-groove and, naturally, deterioration in food of the child are possible
Therefore in need of carrying out operation doctors try to use all opportunities to transfer it to later terms - 14 - 28 weeks (the second trimester) as at this time bodies of the child are created, and excitability of a uterus in response to external influence is minimum.
In the third trimester the risk of complications increases during operation. First of all they are connected with the increasing adverse factors, all organism of the woman during this period works at a limit of the opportunities. At it abdominal organs are displaced and clamped by a uterus, the main blood vessels in a stomach are squeezed, and blood current on them is complicated. The elevated pressure in an abdominal cavity is transferred to a chest cavity, reducing the volume of respiratory movements, that is breath to become more superficial, less effective, and need for oxygen, on the contrary increases: mother breathes for herself and for the grown-up child. The system of coagulability of blood will mobilize all the reserves for a fast stop of bleeding which arises in labor at office of a placenta.
of the Task of the surgeon, the obstetrician and the anesthesiologist can be formulated so:
- to try to delay operation for the period when the risk for the kid is minimum;
- to try to carry out an anesthesia and operation to the minimum terms; by
- to choose an anesthesia method taking into account identity of each patient; to begin with
- in need of the emergency surgery on late terms operation with Cesarean section.
the Modern anesthesiology allows to anesthetize a separate part of the body of the patient, to switch off his consciousness and to anesthetize all body for a long time, to stop breath and to operate it, if necessary - to reduce or increase pressure, to control coagulability of blood, the word - to influence a set of functions of an organism for finding of the person in an anesthesia.the anesthesiologist chooses by
Depending on terms of pregnancy, urgency of operation, its estimated duration and massiveness, specific features of the pregnant woman tactics of anesthesia and such narcotic preparations that:
- as much as possible to protect the child, to support by
- a placentary blood-groove,
- to reduce excitability and to reduce a uterus tone,
- to keep pregnancy.
of the safest for the pregnant woman and her child anesthesia - a type of anesthesia at which anesthetic is entered into space over a firm brain cover of a spinal cord is considered regionarny (epiduralny, conduction). Thus only the lower half of a trunk and the lower extremities are anesthetized. The woman at the same time remains in consciousness. And at impossibility of application of this method (for example, at long and massive operation on abdominal organs) the multicomponent balanced anesthesia with artificial ventilation of lungs through an endotrakhealny tube is used (the mask anesthesia at pregnant women, especially on late terms, is not made from - for big risk of developing of vomiting and its hit in airways - aspiration). Such anesthesia has several tasks: switching off of consciousness, direct anesthesia, removal of all other types of sensitivity, relaxation of muscles, the prevention of emergence pathological reflexes (for example, increases of arterial pressure, change from work of heart, vomiting and so forth) . Respectively, and the list of the preparations applied by the anesthesiologist can be considerable.
Practically any method of anesthesia demands special medicamentous preoperative preparation which can begin even several days prior to operation.
we Will consider the medicinal substances which are most often applied in anesthesiology, we will talk about how they influence the kid and that is done by the doctor to minimize risk.by
the Main preparations applied in anesthesia
Preparations to preparation for anesthesia
Blockers of N - 2 histamine receptors (Ranitidine) 1 are applied to decrease of secretion of a stomach. Preparations enter intramuscularly. These preparations are used without fail in preoperative preparation for the prevention of vomiting. On late terms overdose of preparations of this group is dangerous by negative influence on maturing of nervous system.
Antihistaminic (antiallergenic) preparations (Suprastin, Tavegil, the Dimedrol) possess the same shortcomings, as blockers of N - 2 receptors as the mechanism of their action is similar. However at the correct dosage and at application only according to indications risk of complications for the child - minimum. These preparations are auxiliary, i.e. have no analgesic effect.
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of 1 N - the 2nd histamine receptors control production of digestive juice including in a stomach.
These drugs are injected by
in an organism at a breath in mix with oxygen through an endotrakhealny tube or, in certain cases, an anesteziologichesky mask - to the discretion of the anesthesiologist.
Ftorotan , Izoblyuran , the Halothane enter into this group of preparations. In Russia Ftorotan is more often applied by . This preparation possesses ability to expand bronchial tubes that well in the presence at the patient of bronchial asthma, however can cause violation in matochno - a placentary blood-groove due to expansion of vessels. Therefore most often it is applied as one of components of the combined anesthesia (when several preparations are used). During such anesthesia the woman feels nothing.Nitrous oxide is applied by
sometimes, is short-term also in the lowered doses as one of components of the combined anesthesia at operation of Cesarean section. In such mode she does not manage to work negatively, causes a good dream, relaxes muscles and a uterus. During the combined anesthesia the patient also feels nothing. Whenever possible this preparation is tried not to be used on early terms because NITROUS OXIDE is toxic for the young growing cages and breaks synthesis of DNA, that is can lead to formation of mutations, malformations therefore at prolonged use it can provoke an abortion or damage to development of the child (one of the main reasons for high percent of spontaneous abortions at anesthesiologists and sisters - an anestezistok).by
Preparations to an intravenous anesthesia (are entered into a vein)
Ketamin ( Kalilsol ) it is applied, as a rule, in the third trimester, in the lowered doses, in the absence of contraindication from mother (a hypertension, the increased intra cranial pressure, epilepsy, extreme forms of a gestoz of pregnant women which are followed by spasms). Most often it is applied after extraction of the child in need of manual inspection of a uterus, an ushivaniya of gaps and cuts of a crotch. Ketamin (Kalipsol) in the first and second trimester apply only according to special indications and only in small doses in combination with other preparations as it raises a uterus tone. In the third trimester this its negative effect decreases. Uniqueness of this preparation is that except a dream it causes also rather strong anesthesia. At application of KETAMINA full anesthesia, however its introduction and especially an exit from an anesthesia is reached can be followed by hallucinations.
Preparations of a barbituric row 2 - Geksenal , Tiopental of sodium - are applied by to maintenance of a dream during operation as one of components of the balanced anesthesia, are entered intravenously, can cause temporary oppression of breath in the newborn. Such children have to be under special fixed supervision during the first hours after the delivery.Oksibutirat of sodium is most often applied by
in obstetrics to medication sleep. It is entered intramuscularly or with drink. It is contraindicated at the gestoz of pregnant women (the state which is shown increase of arterial pressure, emergence of protein in urine, hypostases) which is followed by increase of arterial pressure at epilepsy. It is applied also as a component of an intravenous anesthesia in combination with other narcotic preparations. Oksibutirat of sodium, as a rule, does not influence a condition of the child. Treats also preparations of nootropic group, that is improves exchange processes in cells of a brain.
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of 2 Barbiturates - group of the medicines derivative of barbituric acid possessing the somnolent, anticonvulsive and narcotic action caused by the oppressing action on the central nervous system.
Diprivan - a preparation for a short-term anesthesia. It is applied as one of components of the general anesthesia at the beginning or at the end of an anesthesia. Egg and soy protein therefore the preparation is contraindicated to the patients having on them an allergy is Diprivan`s part. The mechanism of impact of Diprivan on development of a fruit is not up to the end studied therefore the preparation is tried to be applied during Cesarean section or at surgeries in time or after the delivery. An exit from an anesthesia after application of this preparation rather favorable if the preparation was applied to short anesthesia at the time of manual office of a placenta or during restoration of integrity of patrimonial ways.
Narcotic analgetics - the safest are considered as of Morphine a hydrochloride and Promedol . It is well known that Morphine of a hydrochloride and Promedol practically has no teratogenny effect (ability to provoke emergence of malformations of a fruit). For the general anesthesia the Fentanyl possessing short-term and very powerful narcotic action is, as a rule, used. In those doses in which this preparation is applied it is not dangerous to the child. Fentanyl intravenously is entered, used as the main preparation for anesthesia. Accustoming to narcotic analgetics both at mother, and at the child even at long operation does not arise because for accustoming of such time of influence of drug it is all the same not enough. However all drugs cause temporary oppression of breath in a fruit. Therefore such children demand continuous supervision during the first hours after the birth. Narcotic analgetics (Promedol, Morphine) use after operations within 2 - 3 days. For this purpose preparations enter intramuscularly 1 - 2 time a day.
of Benzodiazepina is passed through a placenta, and even on deadlines for pregnancy the child is not able to digest them. Preparations of group of Diazepam cause in the newborn breath oppression, temperature increase of a body, falling of arterial pressure and increase in bilirubin blood. Therefore continuous reception of high doses of these preparations is especially undesirable last weeks pregnancies. However their application in anesthesiology both in preoperative preparation, and during operation is necessary therefore they are appointed, but in respectively the picked-up doses.
of Miorelaksanta - the preparations causing relaxation of muscles and respiratory standstill at anesthesia with application of artificial ventilation of lungs. In obstetric practice apply Listenon more often. It practically do not pass through a placenta and collapses directly in mother`s blood for very short time. At long operations apply also other preparations.Local anesthetics (are applied to regionarny 3 and local anesthesia)
Local anesthesia (obkalyvany places of operation) is usually applied by
at small operations. Lidocaine on early terms of pregnancy can get through a placenta, but the organism of the child destroys it even quicker, than the adult`s organism. At overdose if the woman received high doses of a preparation of this group on late terms, at the newborn breath oppression, falling of arterial pressure, heartbeat delay is possible, but it should be noted that when carrying out in the usual mode of anesthesia the calculated doses of preparations have no such effect. At local anesthesia the patient feels a touch in the field of surgery, but pain does not feel.by
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of 3 At regionarny anesthesia anesthetizes one area where surgery is carried out.
the Leading role in obstetric anesthesiology is played by epiduralny anesthesia. It is the safest method of anesthesia for the child and mother allowing to apply the minimum doses of anesteziologichesky preparations at good anesthesia. However from - for pressure drop opportunities at the woman the risk of emergence of violation of blood circulation in a placenta and the fruit hypoxia connected with it remains. In order that to exclude it, before epiduralny anesthesia and during it to the woman intravenously enter physiological solution. At the correct carrying out this method of anesthesia risk for the kid and mother minimum. Epiduralny anesthesia can be carried out as an independent method, and also in a combination with other preparations not only at Cesarean section, but also at operations at the pregnant women who are not connected with obstetric problems. At epiduralny anesthesia give an injection to the lumbar area, enter medicinal substance into space over the firm brain cover covering a spinal cord. At this method full anesthesia of the place of operation is reached. In 4 - 6 hours after epiduralny anesthesia to the woman allow to rise.
When life and health of future mother are under the threat, doctors should take the risk and to perform operations, despite all negative influences and the operation and anesteziologichesky preparations. Its success depends on skill of surgeons and anesthesiologists. The only effective way to reduce risk for itself and the future child is whenever possible to avoid carrying out operation during pregnancy. Therefore before pregnancy the woman has to cure the chronic diseases.
A to future mother should avoid injury-causing situations in every possible way. Our health and health of our relatives is very frequent depends on simple accuracy and attention.