Endotracheal anesthesia for cesarean section on stillborn pregnant patients

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 stillbirth patients is a general anesthetic technique that uses anesthetic drugs after intubation, the main purpose of this method is to help control breathing during pregnancy. during cesarean section stillbirth, and resuscitation after surgery.

1. Under general anesthesia, stillbirth by cesarean section?

The method of general endotracheal anesthesia is applied to cesarean section stillbirth when the pregnant woman is at risk of serious blood clotting disorder, the pregnant woman is stillborn but does not agree to receive spinal anesthesia or has other contraindications. determined not to use conventional spinal anesthesia

2. When is endotracheal anesthesia not possible during a cesarean section for stillbirth?

There are currently no absolute contraindications for the method of general anesthesia through endotracheal intubation in pregnant women with stillbirth. Some relative contraindications include:
Patients who do not agree with endotracheal anesthesia Medical facilities are not qualified, facilities for general anesthesia and resuscitation after cesarean section stillbirth The doctor has not been trained, not well versed in general anesthetic maneuvers

Gây mê toàn thân — Kỹ thuật gây mê nội khí quản khi mổ lấy thai chết lưu chống chỉ định với trường hợp cơ sở y tế không đủ điều kiện, phương tiện để gây mê toàn thân

3. Means of general anesthesia for stillbirth cesarean section

The staff are doctors and nurses who have been trained in the specialty of anesthesiology and resuscitation. System of general anesthesia machine, ventilator, oxygen source. Life function monitors (ECG, arterial blood pressure monitor, SpO2, temperature), defibrillator, viscous aspirator... Laryngoscope, endotracheal tube of all sizes, suction tube , mask, balloon, oropharyngeal cannula Local anesthetic Lidocaine 10% spray Bronchodilator Salbutamol spray Means of preventing difficult intubation such as Cook tube, laryngeal mask, flexible bronchoscope, tracheostomy set management, mouth opening pliers... The patient has met the requirements for general anesthesia and commits to the risks of this method when stillbirth by cesarean section.

4. Prepare the patient before general anesthesia

Pregnant women with stillbirth should have a comprehensive examination before surgery to detect and prevent abnormalities such as the risk of anemia, severe coagulation disorders for blood transfusion and blood products before surgery.
Explain to the patient and family to cooperate and serve the surgery.
Treatment of pregnancy abnormalities such as maternal hypertension, pre-eclampsia, eclampsia, diabetes, mother-child Rhesus incompatibility, infectious diseases...
Some other abnormalities such as abnormal uterus malformed or malformed fetus, umbilical cord knotted, umbilical cord wrapped around the neck, polyhydramnios, oligohydramnios.
Evaluation of the risk of difficult intubation in pregnant women with stillbirth.
Some cases need to use sedation before a cesarean section and stillbirth.

Có tiền sử sản giật — Sản phụ bị tiền sản giật thì cần điều trị các bất thường thai kỳ trước khi gây mê toàn thân

5. Procedure for performing a cesarean section for stillbirth

5.1 General Procedures

Check out the full profile. Check the patient Patient position: lie on your back, breathe oxygen through the cannula at a concentration of 3-6 liters/minute before induction of anesthesia at least 5 minutes. Install a machine to monitor vital signs such as blood pressure, pulse, SpO2 temperature... Establish an effective intravenous line In some cases, pre-anesthesia is required.

5.2 Initiating anesthesia with drugs

Sleeping pills: intravenous anesthetics (propofol, etomidate, thiopental, ketamine...), volatile anesthetics (sevofluran.,Isoflurane..). Painkillers: fentanyl, sulfentanyl, morphine... Muscle relaxants (if needed): succinylcholine, rocuronium, vecuronium....

5.3 Oral intubation technique

Intubation when the mother sleeps deep enough, enough 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 push the tongue to the left, push the light deep in, coordinate with the right hand to press the thyroid cartilage to find the larynx. 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 CANUYN airway in the mother's mouth to avoid biting the tube (if necessary).

5.4 Maintenance of anesthesia

Maintain anesthesia for pregnant women with stillbirth with intravenous or volatile anesthetics, analgesics, muscle relaxants (if necessary). Control breathing by ventilator Monitor depth of anesthesia based on heart rate, blood pressure, sweating... Monitor vital signs: heart rate, blood pressure, SpO2, EtCO2, body temperature. Preventing the endotracheal tube from wrong position, folding, occlusion

thuốc mê tĩnh mạch — Thuốc mê tĩnh mạch được sử dụng nhằm duy trì mê cho sản phụ

5.5 Criteria for extubation

After the cesarean section for stillbirth, it is necessary to remove the endotracheal tube provided that
The patient is awake, following the doctor's orders, Breathing regularly, breathing rate within normal limits Pulse, blood pressure Stable Body temperature above 35 degrees C No complications of anesthesia and surgery

6. Some complications during anesthesia during cesarean section and stillbirth

6.1 Reflux of gastric juice into airway

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.

6.2 Hemodynamic disorders

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

Sản phụ có thể bị rối loạn nhịp tim do rối loạn huyết đông

6.3 Complications due to intubation

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.

6.4 Respiratory complications

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.

Suy hô hấp — Sản phụ bị thiếu oxy cần nhanh chóng thông khí ngay và cung cấp oxy 100%

6.5 Complications after extubation

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. 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.
Customers can directly go to Vinmec Health system nationwide to visit or contact the hotline here for support.

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