Endotracheal anesthesia for cesarean section in patients with lupus

The article was professionally consulted by Specialist Doctor II Le Minh Viet - Anesthesiologist - General Surgery Department - Vinmec Ha Long International General Hospital.

Pregnant women with lupus erythematosus with complications should be indicated for a cesarean section. Endotracheal anesthesia for cesarean section in pregnant women with lupus is performed to control the patient's breathing during and after surgery.

In cesarean section in pregnant women with lupus, the technique of general anesthesia with intubation, also known as endotracheal anesthesia, is used to control the patient's breathing during and after surgery. during surgery.
Endotracheal anesthesia is indicated for pregnant women with lupus erythematosus in the following cases:
Complications: convulsions, blood clotting, myocardial ischemia, pericarditis, neuropathy . Unable or having difficulty controlling breathing with a mask. Regional anesthesia cannot be performed or regional anesthesia is refused.

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

Before carrying out cesarean section, patients with lupus erythematosus should be examined under anesthesia to promptly detect and prevent possible risks, as well as assess difficult intubation.
Procedures for endotracheal anesthesia for cesarean section in pregnant women with lupus 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/minute. Install machines to monitor and set up transmission lines. If necessary, the patient can be given sedatives from the night before surgery. Step 2: Initiation of anesthesia begins with intravenous injection (drugs, etomidate, propofol...), volatile anesthetics (sevofluran...), analgesics (fentanyl, ,sufentanyl, ...), using drugs muscle relaxation if necessary (rocuronium, succinylcholine, vecuronium, ...). It is necessary to ensure conditions for endotracheal intubation during cesarean section in pregnant women with lupus (patients sleep deeply, muscles relax enough). Step 3: Carry out oral intubation as follows: Open the patient's mouth, place one hand under the neck to help straighten the neck, insert the laryngoscope to the right side of the mouth, slide the tongue to the left side of the mouth, and insert the laryngoscope to the left side of the mouth. light in, and at the same time, use the right hand to press the cricoid cartilage to find the lid and glottis Perform rapid induction of anesthesia and perform the Sellick maneuver when the stomach is full (as soon as the patient loses consciousness, press the cartilage wait until intubation is complete) The next step in endotracheal anesthesia for cesarean delivery in patients with lupus erythematosus is to gently intubate the endotracheal tube through the glottis, when the endotracheal tube is ballooned. Pass through the vocal cords Gently remove the laryngoscope Inflate the endotracheal tube. Listen to the lungs, check the EtCO2 reading to check that the endotracheal tube is in place. Use 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 for cesarean section in pregnant women with lupus 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 in pregnant women with lupus, 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. Monitor in case of wrong position of endotracheal tube, or blocked, folded tube. At the end of the process of endotracheal anesthesia for cesarean section in pregnant women with lupus, 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 in pregnant women with lupus may occur some complications that need to be handled 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. Insert a gastric tube to drain gastric juice before extubating the endotracheal tube Hemodynamic disturbances: Depending on the cause and symptoms such as arrhythmia, hypertension or hypotension, ... will be treated appropriately. . Difficult intubation under anesthesia for pregnant women with lupus: Switch to a 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, bronchi: Complications during endotracheal anesthesia during cesarean section in pregnant women with lupus may cause difficulty or inability to ventilate, at this time there will be a crackling sound in the lungs or there may also be a crackling sound. 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 when giving anesthesia to pregnant women with lupus causing respiratory complications such as endotracheal tube being folded, retracted or pushed. deep into one lung, open 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, narrowing of the larynx and trachea, upper respiratory tract infections.

Anesthesia for pregnant women with lupus for caesarean section by intubation method should note:
Intubation can cause convulsions, pulmonary hypertension. Lupus erythematosus can cause thrombocytopenia and oropharyngeal bleeding due to disseminated intravascular coagulation. Myocarditis or an ischemic attack from lupus can cause cardiac tamponade and heart palpitations. Use more pain relievers for pregnant women with lupus erythematosus with ligamentous stretching, Lupus arthritis. The differential diagnosis of migraine headache and cerebral vasculitis due to lupus and surgery is essential. Neuropathy in pregnant women with lupus can cause vocal cord paralysis. Long-term use of NSAIDs can increase or decrease the platelet count. Pregnant women who use dexamethasone or prednisone can develop gastrointestinal ulcers and swelling in the face, making intubation difficult. Endotracheal anesthesia for cesarean section in pregnant women with lupus should pay attention to complications during and after surgery, especially those caused by lupus.
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.
Specialist II Le Minh Viet has more than 30 years of experience in the field of Anesthesia - Resuscitation, including more than 2 years as a Medical expert in Yemen and former Head of Anesthesia - Resuscitation Department - Hospital Thanh Nhan, Hanoi. Currently, Dr. Le Minh Viet is an anesthesiologist, Anesthesia Unit - operating room, Vinmec Ha Long International Hospital.
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