Endotracheal anesthesia for cesarean section in diabetic mothers

The article is expertly consulted by Master, Doctor Ton That Quang - Head of Anesthesia - Anesthesia Unit - Department of General Surgery - Vinmec Nha Trang International General Hospital.

Endotracheal anesthesia in surgery for pregnant women with diabetes is a technique of general anesthesia with intubation. The main purpose of this technique is to control breathing during cesarean section and postoperative resuscitation.

Diabetic women with ketoacidosis Occurrence of diabetic retinopathy in pregnant women Diabetic women with loss of automatic function of the cardiovascular system

At present, there are no absolute contraindications to cesarean delivery under general anesthesia in diabetic women. Some relative contraindications include:
Occurrence of diabetic TMJ complications in pregnant women, difficulty in intubation and general anesthesia. Medical facilities are not qualified, lack of anesthesia and resuscitation facilities. The operator is not technically proficient.

Specialist doctors and nurses have been trained in general anesthesia through endotracheal tubes as well as methods of resuscitation and management of complications caused by anesthesia.

System of anesthesia machine, ventilator, oxygen source, monitor to monitor vital signs, defibrillator, suction machine... Intubation instruments such as laryngoscope, endotracheal tube size, straw, mask, balloon, oropharyngeal canul... Some drugs to support intubation: Lidocaine 10% spray, Salbutamol spray. Support equipment for difficult intubation: Cook tube, laryngeal mask, flexible bronchoscope, tracheostomy kit, ...

Pregnant women with diabetes need to have a comprehensive examination before cesarean section under general anesthesia, have been explained the risks as well as possible complications.
Pregnant women should be evaluated for difficult intubation.

Check administrative records, patient's name before the procedure. For pregnant women to lie on their backs, give oxygen through the nose at a concentration of 3-6 l/min at least 5 minutes before induction of anesthesia.
Install a monitor to monitor vital signs such as pulse, blood pressure, breathing rate, SpO2... Establish an intravenous line (used in emergency situations).
Conduct induction of anesthesia with appropriate drugs and doses:
Anesthesia: intravenous anesthetics (propofol, etomidate, thiopental, ketamine...), volatile anesthetics (sevoflurane...). Painkillers: fentanyl, sufentanil, morphine... Muscle relaxants (if needed): (succinylcholine, rocuronium, vecuronium...). After using the drugs, conduct endotracheal intubation when the patient is in deep sleep and has enough muscle relaxation. Oral intubation technique:
Right hand open the mother's mouth, tilt the patient's neck. The left hand holds the laryngoscope and inserts it into the mother's mouth from the right side of the mouth, moves the tongue to the left and pushes the lamp deep in, in coordination with the right hand to press the cricoid cartilage to find the epiglottis and glottis. Perform rapid induction of anesthesia. Gently insert the endotracheal tube through the glottis under the guidance of the lamp. When the balloon of the endotracheal tube passes through the vocal cords 2-3 cm, it stops. Inflate the tube insert to fix the tube in the trachea in diabetic women

Check that the tube is positioned correctly in the trachea by squeezing the balloon through the endotracheal tube while listening to the lung sounds and observing the patient's SpO2. When the endotracheal tube is in the correct position, gently withdraw the laryngoscope. Secure the tube with adhesive tape. Place the canul in the mouth to avoid biting the tube (if necessary). Maintain anesthesia during cesarean section with intravenous or volatile anesthetics, analgesics, and muscle relaxants (if needed). Control the gas exchange of the mother with a ventilator or hand squeeze the balloon. Monitor vital signs: heart rate, blood pressure, SpO2, body temperature during cesarean section of pregnant women with diabetes.

Diabetes in pregnant women is a very common complication of hypoglycemia, so it is necessary to prevent this complication during cesarean section by monitoring the mother's blood glucose concentration. Special attention should be paid to the syndrome. Temporomandibular joint stiffness in diabetic women because it will make intubation difficult. Some situations need to switch to another method of anesthesia such as regional anesthesia (but be aware of epidural abnormalities due to connective tissue disease in pregnant women with diabetes) Regional anesthesia includes spinal anesthesia and local anesthesia. Epidural is still an appropriate choice for pregnant women with diabetes if not contraindicated. Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of highly qualified medical professionals, well-trained, domestic and foreign, and experienced.
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Master. Dr. Ton That Quang has more than 15 years of experience working in the Anesthesia - Resuscitation industry. Doctor Quang was a doctor at the Department of Anesthesiology and Resuscitation at Khanh Hoa General Hospital and a lecturer at the provincial level of Emergency Resuscitation in Obstetrics and Gynecology before being an Anesthesiologist and Resuscitation Doctor at the Department of General Surgery, General Hospital. Vinmec Nha Trang International.
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