Endotracheal anesthesia for cesarean section in patients with preterm placental abruption

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

Endotracheal anesthesia for cesarean section on patients with placental abruption is a technique of general anesthesia using anesthetic drugs after intubation. The main purpose of this method is to help control breathing during cesarean section, and to resuscitate after surgery.

Endotracheal anesthesia for cesarean section in patients with placental abruption in case of uterine stiffness, pain, fetal distress, shock, blood loss, blood clotting disorders In addition, this technique is also applied to patients refuse or have contraindications to regional anesthesia.
Endotracheal anesthesia for cesarean section surgery in people with placental abruption is contraindicated in cases where the patient does not agree with endotracheal anesthesia, medical facilities are not qualified for general anesthesia and resuscitation. After cesarean section, the doctor is not trained or proficient in the manipulation of general anesthesia.
Person performing endotracheal anesthesia
Nursing doctor specializing in anesthesiology and resuscitation Prepare equipment for surgical endotracheal anesthesia
Anesthesia machine system, ventilator, oxygen source System of function monitoring machine vital capacity (ECG monitoring, arterial blood pressure measurement, arterial blood gas SpO2, EtCO2, respiratory rate measurement, body temperature measurement) Defibrillator Suction machine Laryngoscope Laryngoscope Endotracheal tube Suction tube Mask Ball Oropharyngeal squeezing pliers Magill Mandrin soft pliers Lidocaine 10% spray, bronchodilator Salbutamol spray Means of preventing difficult intubation such as Cook tube, laryngeal mask, flexible bronchoscope, airway opener Administer, mouth-opening pliers... Preparing the patient before general anesthesia blood Explain to the patient cooperation, for the surgery Assess the risk of difficult intubation in pregnant women with placental abruption Some cases need to use this method. sedation the night before the cesarean section

Check the complete records (consultation card, consultation minutes, commitment) Check the patient (hospitalization number on the pregnant woman's bracelet, fasting time before surgery, check dentures... ) Put the patient in supine position, breathe oxygen through the cannula at a concentration of 3-6 liters/minute at least 5 minutes before induction of anesthesia. Install a monitor to monitor vital signs such as blood pressure, pulse, SpO2 temperature... Establish an effective intravenous line Give the patient an H2-receptor antagonist and Metoclopramide (an antiemetic) Some In cases where pre-anesthesia is required

Sleeping drugs: intravenous anesthetics (propofol, etomidate, thiopental, ketamine...), volatile anesthetics (sevoflurane...). Painkillers: fentanyl, sufentanil, morphine... Muscle relaxants (if needed): succinylcholine, rocuronium, vecuronium...

The condition for endotracheal intubation is that the patient must sleep deeply and have sufficient muscle relaxation.
Open the patient's mouth, place one hand under the neck so that the neck is straight, insert the laryngoscope to the right of the patient's mouth, then move the tongue to the left, push the light deep in, coordinate with the right hand to press the thyroid cartilage to find the lid glottis and glottis. Initiate rapid induction of anesthesia and perform the Sellick maneuver in case of a full stomach. Continue to intubate the endotracheal tube gently through the glottis, stop when the endotracheal tube passes through the vocal cords from 2-3 cm, then gently withdraw the laryngoscope, inflate the endotracheal balloon. Check the correct position of the endotracheal tube (based on bilateral auscultation and on EtCO2 results), and then secure the tube with adhesive tape. Put the airway in the mother's mouth to avoid biting the tube (if necessary).

Maintain anesthesia with intravenous/volatile anesthetics, analgesics and muscle relaxants (if necessary). Control the patient's breathing with a ventilator. Monitor the depth of anesthesia (monitor heart rate, blood pressure, sweat, tears...). Monitor vital signs. Be careful with the endotracheal tube in the wrong position, flexion, obstruction.

The pregnant woman is awake, can follow the command, the muscle relaxer is completely neutralized. Lift the patient's head for more than 5 seconds, the TOF index >0.9 (if any) Postoperatively, the patient can breathe spontaneously. Normal term Stable pulse and blood pressure Body temperature above 35 degrees C. No complications from anesthesia and surgery

This complication occurs when there is digestive juices in the oral cavity and airways of the pregnant woman. At that time, the patient needs to be drained immediately, lying with the head low or tilting the head to the side.
In some cases, it is necessary to quickly re-intubate the endotracheal tube and remove the fluid in the airway through the newly placed endotracheal tube. Pregnant women need to be monitored for signs and prevent lung infections after surgery.

Common hemodynamic disturbances include hypotension or hypertension, cardiac arrhythmias (bradycardia, tachycardia, arrhythmia). Patients should be treated according to symptoms and causes.

If endotracheal intubation is not possible, it should be handled according to the difficult intubation procedure or switched to another method of anesthesia. If placed in the stomach by mistake, check by auscultation without alveolar murmur. Once there, remove the tube and reposition the endotracheal tube in the correct position.
Common injuries such as bleeding, broken teeth, damage to the vocal cords, falling foreign bodies into the airways... Pregnant women should be treated promptly depending on the type of injury.
Constriction of the vocal cords - air - bronchi leads to difficulty or inability to ventilate, the lungs will have rales or muted lungs. At that time, it is necessary to provide adequate oxygen, add sleeping pills and muscle relaxants to the mother, ensure ventilation, give bronchodilators and corticosteroids. If breathing is still not controlled, a difficult intubation procedure should be used.

There may be complications during cesarean section with endotracheal anesthesia such as folding, intubation of the endotracheal tube or the tube being pushed deep into one lung, respiratory failure or openness, lack of oxygen, soda. eliminate the effects of hypoxia and hypercapnia. At that time, it is necessary to ensure immediate ventilation and provide 100% oxygen, along with finding and solving the cause.

Patients may have respiratory failure after extubation for a variety of reasons. Sore throat hoarse voice. Constriction of the larynx-trachea-bronchi. Upper respiratory tract infection . laryngotracheal stenosis.

Beware of the risk of thromboembolism and the risk of drug allergy in the mother. Be careful of complications caused by blood transfusion with large blood volume. Beware of severe coagulopathy that can be fatal to the mother. Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading doctors, modern equipment and technology, but also stands out for its examination and consulting services. and comprehensive, professional medical treatment; civilized, polite, safe and sterile medical examination and treatment space.
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