Anesthesia of labor during abnormal labor

Acupuncture with weakness of labor. The conducted research has shown that under the conditions of using electroacupuncture for the treatment of weakness of labor activity, qualitatively other changes in the contractile activity of the uterus occur, than against the background of the use of drug-induced rhythmostimulation. These changes contribute to the faster completion of labor, without causing deterioration of the fetus.

Anesthesia with weakness of labor. With the primary weakness of labor and the opening of the uterine pharynx by 4 cm, the most effective use of the following combinations of drugs in the normal psychosomatic state of the mother is pifolen at a dose of 25-50 mg and promedol at a dose of 20 mg intramuscularly in one syringe and spasmolytic gangleron at a dose of 30 mg intramuscular and spasmolithine in a dose of 100 mg orally. In this case, the importance of data on the nature of rhodostimulation when using painkillers.

With insufficient effectiveness from the first round of rhythm stimulation, with an interval of 2 h, a 2-nd round of rhythm stimulation consisting of 4 powders of quinine inwards and 5 injections of oxytocin at the same dose and with the same intervals as during the first round of rhythmostimulation is prescribed.

Ataralgesia dipidolor and neuroleptanalgesia. Simultaneously with the appointment of the first round of rhythm stimulation, a halidor is administered at a dose of 50-100 mg intramuscularly or intravenously.

In the following, ataralgesia - 2 ml (15 mg) of dipidolor and 2 ml (10 mg) of seduxen or neiroleptanalgesia-fentanyl 2 ml (0, 2 mg) is used with 2-3 injections of oxytocin (1st round of rhythm stimulation) in the presence of painful fights and expressed psychomotor agitation. 1 mg) and droperidol 2 ml (5 mg). Both mixtures are administered intramuscularly.

As with the use of ataralgesia, and with the use of neuroleptanalgesia, the mental tension in the parturient women decreases, the pain threshold significantly increases. The period of disclosure during the normal duration of the periods of expulsion and the post-war period is clearly shortened.

Discoordinated labor activity

One of the leading clinical symptoms characterizing the discoordination of labor is severe permanent pain in the lower abdomen and in the lumbar region, which do not cease between contractions, which causes inappropriate behavior of the parturient woman, since the pain intensity does not correspond to the force of contractions. Therefore, when treating this anomaly of labor, it is necessary to use drugs with pronounced antispasmodic and analgesic effect.

Given these requirements, in the treatment of discoordination of labor can be used as atalgeziyu, and neuroleptanalgesia, but necessarily against the background of spasmoanalegetika baralgina.

The method of treatment of discoordination of labor.

1. Ataralgesia (dipidolor + seduxen). When establishing the diagnosis of discoordination of labor, regardless of the size of the opening of the uterine throat, it is recommended to administer 5 ml of the officinal solution of baralgina in a mixture with 15 ml of isotonic sodium chloride solution intravenously, and intramuscularly 2-3 ml (15-22.5 mg) of dipidolor and 3 -4 ml (15-20 mg) of seduksen (depending on the weight of the parturient mother). Repeated administration of drugs is usually not required, as generic activity acquires a coordinated character.
2. Neuroleptanalgesia (droperidol + fentanyl). Intravenously, in a mixture with 15 ml of isotonic sodium chloride solution, 5 ml of the officinal solution of baralgina (regardless of the degree of opening of the uterine throat) are injected. After 1 h, 3-4 ml of 0.25% solution of droperidol and 3-4 ml of 0.005% solution of fentanyl are intramuscularly administered. Repeated administration of droperidol is not required, and repeated administration of fentanyl is necessary no earlier than in 1-2 hours, as during discoordination of labor activity, the duration of labor is shortened by 2-4 hours compared with those who received other analgesic drugs.

The combination of baralgina with drugs for ataralgesia and with drugs for neuroleptanalgesia is advisable to apply for discoordination of labor even if there is a preserved and mature cervix, with regular bouts. These drugs do not have a negative effect on the maternity and the condition of the intrauterine fetus and newborn.

Excessive labor activity. For the purpose of the regulation and anesthesia of labor during excessive labor, a combination of neurotropic drugs (aminazine or propazine in a dose of 25 mg) is recommended in combination with solutions of promedola 20-40 mg and pipolfen 50 mg intramuscularly, and in the absence of effect, an additional anesthetic anesthesia is used.

A high regulating effect gives the use of inhalations of fluorotan in a concentration of 1.5-2.0% by volume. In this case, the use of ftorotan leads literally in the first 2-5 minutes to normalize labor activity, with an increase in the concentration of fluorotanum to 2% and more, an almost complete stop of labor activity occurs. Simultaneously, the normalization of palpitation of the fetus is noted. However, it should be noted that the use of ftorotan is not an etiopathogenetic method for the treatment of excessive labor. If the cause of excessive labor is not eliminated, and if ftorotan inhalation lasts less than 20-30 minutes, after termination of inhaled ftorotane, excessive generic activity may reappear. In recent years, the use of beta-adrenomimetics such as partusisten, sugopara, ritodrin in the complex treatment of excessive labor has been increasingly used.

Long peridural analgesia in childbirth. One of the most promising and most effective methods of anesthesia of complicated labor (late toxicosis, cardiovascular diseases, abnormalities of labor) is a long peridural analgesia.

Long-term epidural analgesia is indicated in the presence of sharply painful fights with complicated labor and regular regular labor during opening of the uterine throat 3-5 cm.

Puncture and catheterization of the epidural space (performed by an anesthesiologist) is performed on a gurney in the position of the parturient on the side (right) with the legs brought to the abdomen. After identifying the epidural space (test failure and loss of resistance, free introduction of the catheter, the absence of solution from the needle), a test dose of anesthetic (2-3 ml of a 2% solution of trimecaine or equivalent doses of novocaine or lidocaine) was injected through the needle. Five minutes after the absence of signs of a spinal block through the needle in the cranial direction, a fluoroplastic catheter is inserted 2-3 times above the needle (T12-L2,), the needle is removed and a dose of anesthetic is injected through the catheter (10 ml of a 2% trimecaine solution or 15 ml of 1 % solution of lidocaine or 10 ml of a 2% solution of novocaine). Repeated administration of an anesthetic through a catheter is performed with the resumption of pain. Usually the administered dose of anesthetic causes analgesia for 40-60 minutes.

To ensure a truly continuous and uniform infusion of anesthetic throughout the analgesia by drop method is technically impossible, because only due to atmospheric pressure and gravity of the anesthetic solution itself, its free flow into the epidural space along a thin catheter from the drop system is possible only with an open clamp; This speed exceeds the required (on average 10 ml / h). Its stable adjustment is possible within 7 drops in 1 min or more, which is 2 times higher than necessary. An exact change in the rate of infusion by means of the clamp system is also not possible, since 1 ml / h corresponds to 0.32 drops per minute. The fact that the pressure in the epidural space in parturient women is not only increased, but also varies depending on the contractile activity of the uterus (Messih), and also that the difference in the rates of free flow of solution from the system, depending on the filling of the bottle, is great (12.3 ml / h), complicates not only the installation and maintenance of the optimal infusion rate, but also its precise determination, as well as the doses of the injected anesthetic - both per unit of time and finally.

In conclusion, it should be noted that the combination of the use of physiopsychoprophylaxis and medical anesthesia of normal and especially complicated births (late toxicosis of pregnant women, certain cardiovascular diseases, anomalies of labor) allows us to obtain a more pronounced analgesic effect, to achieve normalization of labor through direct myotropic, central action, as well as the normalization of blood pressure and other vital body functions.

[1], [2], [3], [4], [5], [6], [7],