Method of subdural anaesthesia as anaesthetic management of cervical suturing surgery

FIELD: medicine.

SUBSTANCE: puncture point is anaesthetised by 0.5% bupivacaine. It is followed by puncture of a subdural space with the use of a spinal needle at the level of L3-4, L4-5 from a medial approach. A local anaesthetic is presented by hyperbaric 0.5% bupivacaine 0.8-1.2 ml. The patient is kept seating for 10 minutes.

EFFECT: method enables adequate anaesthesia with ensured maximum perineal myorelaxation combined with decreased drug-induced load on mother's and foetus's bodies.

1 ex

 

The invention relates to medicine, namely to anesthesiology and critical care medicine, may be actively used as anesthetic management operations suturing on the cervix.

The known method of anesthesia ensure small obstetric manipulations (including suturing on the cervix when isthmic-cervical insufficiency), providing for total intravenous anesthesia by a variety of means for anaesthesia, when this is achieved 1-2 stage surgical anesthesia sufficient for surgery (3).

Traditionally used schema

Premedication (atropine sulfate at a dose of 0.3-0.6 mg and midazolam in a dose of 2.5 mg/m). The most secure and accessible is General anesthesia using ketamine. Ketamine 1-3 mg/kg body weight intravenously. Adverse effects of ketamine (hallucinations and agitation in the early postoperative period, nausea, vomiting, spatial disorientation) occurs in 20-45% of cases. Contraindications to the use of ketamine is gestosis, arterial hypertension of various etiologies, mental diseases in history.

Another widely used anesthetic was propofol. Recommended dosage: propofol 40 mg every 10 seconds in/veno before the appearance of clinical symptoms of anesthesia. The average dose 1,and 2.5 mg/kg of body weight. An undesirable effect of propofol is its irritant effect on the intima of blood vessels. Teratogenic effects of propofol in the experiment was not revealed, but the manufacturer does not recommend the drug in the first and third trimesters of pregnancy (1, 2).

However, this method of carrying out manuals has several disadvantages:

1. Insufficient relaxation of the pelvic floor muscles with the limitation of operational space for surgeons.

2. The need for adequate protection of the respiratory tract.

3. The teratogenicity of the drugs used in systemic use.

4. The high incidence of nausea and vomiting in the postoperative period.

5. Pain requiring additional drug therapy.

6. In the early postoperative period, some patients require additional analgesia by intravenous analgesics, enforcement regime, the introduction of drugs that reduce the tonus of the uterus.

Consider using subdural anesthesia when applying cervical suture is more preferable because it is much smaller compared with total intravenous anesthesia drug effects on the fetus. However, accurate data on the advantage subdural anesthesia over General are absent (4).

A method of conducting subdural anesthesia GUI is barechested by bupivacaine in an overlay operation cervical suture:

The technical result of the invention is the reduction of drug effects on the body of the mother and fetus (in the period of embryonic bookmark of organs and systems), creating an optimal surgical comfort, ensuring adequate and safe postoperative analgesia compared with total intravenous anesthesia.

This goal is achieved as follows: traditionally, the patient should be assessed before surgery anesthesiologist-resuscitator order to determine the physical status of the patient and anesthetic risk, drafting a plan for the benefit of signing the consent to the procedure. The treatment includes the application of atropine sulfate at a dose of 10 mg/kg of body weight, ensuring adequate venous access through the catheter and a peripheral vein, the bondage of the lower limb compression bandages. Subdural anesthesia is performed under aseptic conditions with standard processing designated puncture the methodology adopted in the hospital. The patient is sitting. Anesthesia designated puncture is performed with a solution of bupivacaine 0,5%. Puncture is performed by a spinal needle at the level of L3-4, L4-5median access. As a local anesthetic is used hyperbaric solution of bupivacaine 0.5% in doses of 0.8-1.2 ml In this sitting position save is applied to 10 minutes, that allows you to limit the Rostral spread of hyperbaric local anesthetic and reduce the risk of hypotension (5). Next is laying the patient in a chair with a raised head end by 30%. Initially sitting position and the subsequent laying with a raised head end allow you to limit the area of anesthesia exclusively pelvis, i.e. the sensor unit is limited by the crotch. During anesthesia observed monitoring patient safety. Qualitative sensory blockade achieved through 10-12 minutes after subdural injection of anesthetic and lasts for two hours. After performing surgical procedures, patients are transferred to the Department of pregnancy pathology for further medical follow-up.

The use of this technique was able to achieve high-quality relaxation of the perineum and deep and prolonged anesthesia without depressive impact funds for intravenous anesthesia, to avoid additional prescriptions of analgesics after surgery.

Example

Patient S. 29 years old, height 167 cm, weight of 73.5 kg, gestational age of 14 weeks, hospitalized for applying a U-shaped seam on the cervix with a diagnosis of isthmic-cervical insufficiency, threatening miscarriage. During the day, patients underwent a clinical-biogi the practical examination. Standard preoperative preparation (peripheral venous access, monitoring breathing rate, blood pressure, heart rate, degree of saturation of capillary blood by oxygen, tight compression of the lower extremities). In terms of subdural anesthesia performed surgical correction. In the sitting position made puncture cerebrospinal space medial access in the segment of L4-5needle for spinal anaesthesia. In the subdural space introduced hyperbaric solution of bupivacaine 0.5% and 0.9 ml, exposure time in a sitting position up to 10 minutes, then is laying the patient in a chair with a raised head end by 30%. Adequate sensory blockade (Th10-Th12) occurred on 9-10 minutes. Motor block Bromage II. During anesthesia smooth. Feel satisfactory. Breathing is an independent, effective rate 16 breaths per minute, against inhalation of oxygen saturation of capillary blood oxygen 98-99%. Stable hemodynamics (blood pressure 115/75-95/65 mm Hg, HR - 82-70 beats in one minute. Diuresis adequate 55-60 ml/h In the early postoperative period, the anesthesia was not required. The duration of spinal block was about 1.5-2 hours.

The invention can be recommended for application method subdural anesthesia during operations overlay weld on the side of the uterus. This technique has the following advantages:

- eliminates the risk of aspiration complications;

- minimizes drug effects on the fetus;

- provides effective postoperative analgesia;

- provides an effective relaxation of the pelvic floor muscles;

the relatively simple technique of the procedure;

- due to more complete blockade (compared with General anesthesia) stress reactions contributes to the preservation of humoral and cellular immunity, which reduces the number of purulent-septic complications in the postoperative period.

Sources of information

1. Kulakov V.I. Obstetrics and gynecology. Clinical recommendations. - Moscow, Geotermia, 2006

2. Lysenkov S. p., V.V. Myasnikov, Ponomarev V. the state of Emergency and anesthesia in obstetrics. S.-Petersburg, 2004, str-576.

3. Gelfand BYR, Kiriyenko P.A., Grinenko TF Gur'yanov, V.A. and others Anesthesiology and intensive care: a Practical guide. Moscow, 2006, str.

4. Mulroy M Local anesthesia./ Edited by Prof. Emelyanov, S. Moscow. 2005, str.

5. Hawking, the Distribution of local anesthetics with spinal space. Update in Anaesthesia issue # 14 April 2009, p.24-29.

Way for subdural anesthesia hyperbaric bupivacaine with an overlay operation cervical suture, ex is different, however, what anesthesia designated puncture performed with 0.5%solution of bupivacaine, and then puncture the subdural space of the spinal needle at the level of L3-4, L4-5median access as a local anesthetic use of hyperbaric 0.5%solution of bupivacaine in doses of 0.8-1.2 ml, while the sitting position of the patient retain up to 10 minutes



 

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