Endotracheal anesthesia for cesarean section in women with epilepsy

The article was professionally consulted with Master, Doctor Ton That Quang - Head of Anesthesia - Anesthesia Unit - Department of General Surgery - Vinmec Nha Trang International General Hospital.

Endotracheal anesthesia for cesarean section on epileptic women or those with a history of epilepsy is a technique of general anesthesia with intubation. The purpose of this method is to control the mother's breathing during surgery and to support postoperative resuscitation.

Endotracheal anesthesia for cesarean section is indicated:
Pregnant women with epilepsy Women with a history of epilepsy Pregnant women having seizures during labor. Epilepsy is defined as a mental disorder in which brain activity is altered, causing convulsions or periods of abnormal behavior and sensations, sometimes with a brief loss of consciousness.
Note that endotracheal anesthesia for cesarean section should not be performed in pregnant women with epilepsy at medical facilities that do not have enough facilities for anesthesia - resuscitation or technicians who are not proficient in professional techniques.

Performer Specialist nurse anesthesiology and resuscitation Equipment preparation Anesthesia machine system with breathing oxygen source Hand squeeze oxygen system Life function monitoring system (monocardiogram, arterial blood pressure measurement, gas arterial blood SpO2, EtCO2, respiratory rate measurement, body temperature measurement) Defibrillator Suction machine Laryngoscope Laryngoscope Endotracheal tube Suction tube Mask Balloon oropharyngeal Cavitation Pliers Magill, soft mandrin. Local anesthetic Lidocaine 10% spray Salbutamol spray. Means of prevention in case of difficult intubation: Cook tube, laryngeal mask, flexible bronchoscope, tracheostomy kit, mouth opener...

Prepare patient for cesarean section Perform pre-anesthesia exam to detect and prevent risk of generalized or partial seizures Explain to patient Evaluate difficult intubation Administer medication safely the night before the cesarean section (if necessary).

Checking records includes: consultation form, consultation minutes (if any), written commitment... Checking the hospital admission number on the pregnant woman's bracelet, checking the fasting time of the pregnant woman and her teeth fake. Put the mother in the supine position, breathe 100% oxygen 3-6 liters / min, start at least 5 minutes before the induction of anesthesia. Install the tracker Set up the transmission. Perform pre-anesthesia (if necessary).

Sleeping drugs: intravenous anesthetics (propofol, etomidate...), volatile anesthetics (Isoflurane...). Pain relievers: fentanyl, sufentanil Muscle relaxants (if needed) include: succinylcholine, rocuronium, vecuronium.

Conditions for placing an oral endotracheal tube for an endotracheal anesthetic woman during cesarean section is that the patient must sleep deeply and achieve sufficient muscle relaxation. The technician opens the mother's mouth, puts her hand under the neck so that the neck is straight, inserts the laryngoscope to the right of the patient's mouth, then moves the tongue to the left, pushes the light deep in, the right hand coordinates the cricoid cartilage to find the lid. glottis and glottis. Perform rapid induction of anesthesia and Sellick maneuver in case of full stomach (20-30 N cricoid compression) as soon as the patient loses consciousness until the intubation is complete). 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 endotracheal tube position (based on bilateral auscultation and on EtCO2 results) Secure the endotracheal tube with adhesive tape. Insert the cannula into the mouth to prevent the patient from biting the tube (if necessary). In the case of difficult intubation, a difficult intubation procedure should be applied.

Maintain anesthesia with intravenous anesthetics (ketamine should be avoided), isoflurane volatile anesthetics (sevoflurane should be avoided because it can cause seizures), and use additional analgesics and muscle relaxants (if necessary). Control the mother's breathing with a machine or squeeze by hand. Monitoring the depth of anesthesia (monitoring heart rate, blood pressure, sweat, tears, MAC, BIS, Entropy...). Monitor vital signs: heart rate, blood pressure, body temperature, SpO2, EtCO2 Be careful with endotracheal tube in wrong position, flexion, obstruction.

Pregnant women are awake, can follow orders, muscle relaxants have been completely neutralized. Raise the patient's head for more than 5 seconds, the TOF index > 0.9 (if any). After surgery, patients can breathe on their own. The respiratory rate is within normal limits. Pulse and blood pressure are stable. Body temperature over 35 degrees Celsius. No complications of anesthesia and surgery.

Reflux of gastric juice into the airway: it is necessary to drain the fluid, place the mother with her head low and tilted to one side, quickly insert the endotracheal tube and drain the fluid, monitor the mother and prevent lung infections. Hemodynamic disorders: increase and decrease in blood pressure, cardiac arrhythmias Accidents caused by failure to intubate, mistakenly placed in the stomach, due to laryngotracheal-bronchospasm, trauma when intubating... respiratory symptoms: retraction, folding or endotracheal tube pushed deep into one lung, open respiratory system, no oxygen source... Complications after extubation: posterior respiratory failure, sore throat hoarseness, spasm larynx-trachea, upper respiratory tract infection, laryngotracheal stenosis...

Pay attention to maternal drugs used to treat epilepsy such as Carbamazepine, Phenytoin, Valproate, Phenobarbital, gabapentin or lamotrigine... Pay attention to side effects caused by antiepileptic drugs such as drowsiness, dizziness, depression and anxiety. increases the risk of seizures in pregnancy, thrombocytopenia, or myelosuppression anemia. Note that Ketamine, Enflurane and Meperidine should be avoided because the drug can lower the seizure threshold, which can easily lead to seizures. Sevorane has more seizure-inducing properties than Isoflurane. Treatment of convulsions during intubation can be treated with benzodiazepines. Anesthesia may include thiopental and succinylcholine, oxygen maintenance, nitrous oxide and isoflurane. Women taking Phenytoin are often resistant to Vecuronium, not to Atracurium. 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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