Medical anesthesia of normal delivery

1. When a woman in labor arrives in the maternity department and the phenomena of feelings of fear, anxiety, uncertainty, mental stress or emotional excitement, tranquilizers - trioxazine in a dose of 300-600 mg orally, or diazepam in a dose of 5-10 mg, or phenazepam 0.0005 g in combination with spasmolithine, which also has a sedative and spasmolytic effect. A single single dose of spasmolytin is 100 mg orally.
2. In the presence of regular labor and the opening of the uterine throat for 3-4 cm in childbirth with a pronounced psychomotor agitation apply the scheme. No. 1, which includes the following components:
   • - Aminazine - 25 mg (2.5% solution - 1 ml);
   • - Pipolphen - 50 mg (2.5% solution - 2 ml);
   • - promedol - 20 mg (2% solution - 1 ml).

These substances are administered intramuscularly in a single syringe.

3. In parturient women, in the absence of abnormalities in the psycho-somatic state, the presence of regular labor and the opening of the uterine throat, the following combinations of drugs are also introduced for 3-4 cm: (Scheme No. 2):
   • propazine - 25 mg (2.5% solution - 1 ml);
   • pipolphen - 50 mg (2.5% solution - 2 ml);
   • Promedol - 20 ml (2% solution - 1 ml).

This combination of substances is also administered intramuscularly in one syringe.

If there is an insufficient analgesic effect from the administration of these agents, these preparations can be reintroduced in a half dose at intervals of 2-3 hours. In the parturient women who have a pronounced sedative but insufficient analgesic effect after the administration of scheme No. 1 or No. 2 the same interval, you can enter only one promedol in a dose of 20 mg, intramuscularly.

4. With a view to a more pronounced and long-lasting analgesic effect, as well as relaxation of the pelvic floor muscles and perineum, it is advisable after applying the scheme No. 1 or No. 2 at the end of the opening period in the re-parenting or at the beginning of the expulsion period in the primipara, ie, 30-45 minutes before birth of a child, give birth intravenously 10% solution of mephedol - 1000 mg on a 5% solution of glucose (500 mg). In this case, the introduction of a solution of mephedol is carried out slowly for 1-1.5 minutes. It is possible to introduce another central muscle relaxant, which is close in its pharmacological properties to mephediol, but which does not depress respiration in parturient women. The combined use of neurotropic drugs with analgesics and mephedol according to the method described above makes it possible to achieve pronounced and longer anesthesia of childbirth in the first and second stages of labor. A very significant circumstance is that it is possible to avoid undesirable influence of anesthetics on the respiratory center of the fetus.

Anesthesia of normal delivery with neurotropic drugs with analgesics and inhalation anesthetics from the group of halogen-containing

1. When a woman in labor arrives, tranquilizers are assigned to the maternity ward and then scheme No. 1 or No. 2.
2. If there is insufficient anesthetic effect when using these schemes, the latter can be combined with the use of inhalational anesthetics - trichlorethylene in a concentration of 0.5% by volume, fluorotanum - 0.5% by volume or methoxyflurane - by 0.4-0.8% by volume. Preliminary administration of neurotropic drugs (tranquilizers, propazin, pifolen), which cause a pronounced sedative effect, also enhances the effect of inhalation anesthetics, so that a significantly lower amount of anesthetic is required for pronounced analgesia in childbirth.

The technique of trichlorethylene in combination with neurotropic drugs and analgesics. 1-2 h after the administration of scheme No. 1 or No. 2, when there is a pronounced sedative but insufficient analgesic effect, trichlorethylene inhalations are used. At the same time, during the first 15-20 minutes, the trichlorethylene concentration should be 0.7% by volume, then its concentration is maintained in the range of 0.3-0.5% by volume. Inhalations of trichlorethylene are carried out with the active participation of the parturient woman at the time of the contraction. At the same time, the woman in childbirth has the opportunity to stay in contact with the doctor or obstetrician leading the birth all the time. The duration of analgesia should not exceed 6 hours. The total amount of trichlorethylene consumed averages 12-15 ml.

The procedure for the use of ftorotan in combination with non-thyrotropic drugs and analgesics. In pregnant women in the presence of frequent and intense fights, accompanied by severe pain after the introduction of scheme No. 1 or No. 2 after 1 1/2 to 1 hour, the use of inhaled ftorotan in a concentration of 0.3-0.5% by volume, which, along with a pronounced analgesic effect, contribute to the normalization of labor and the smoother course of the period of disclosure and the period of exile. The duration of inhalation of fluorotan should not exceed 3-4 hours.

Method of methoxyflurane in combination with neurotropic drugs and analgesics. After the introduction of scheme No. 1 or No. 2 after 1-1.2 hours. In women with a pronounced psychomotor agitation, it is more expedient to use methoxyflurane (pentran). In this case, you can use a special evaporator "Analgizer" of the company "Abbot", which allows you to create an analgesic concentration of methoxyflurane - 0.4-0.8% (maximum concentration of anesthetic). The procedure for conducting autoanalgesia is as follows: the woman in labor closely surrounds the oral end of the Analgizer with her lips and makes deep breaths through it, exhaling through the nose. After 8-12 breaths, when the mother is accustomed to the smell of anesthetic, the opening of the dilution is closed with a finger. The parturients easily adapt to the apparatus and regulate the analgesia themselves after appropriate instructions. Inhalation of pentane can be performed by the domestic Trilan apparatus, into which 15 ml of pentane is poured (for 2 hours of pentane inhalation in labor). The use of the Trilan device facilitates the passage of gas flow through the evaporator of the device only during inspiration, which ensures a more economical use of the anesthetic compared to the Analgiser and, thanks to a good seal, anesthesia can be more effective. With the onset of the second stage of labor, the use of inhalation anesthetics may not cease. Anesthetic does not affect negatively the contractile activity of the uterus, the state of the intrauterine fetus and the newborn.

The method of analgesia of normal delivery with neurotropic drugs with analgesics and non-steroidal steroid drugs. In connection with the fact that non-inhaling steroid drugs (viadryl, sodium oxybutyrate) do not have a sufficient analgesic effect in doses used in obstetric practice, it is advisable to use them against neurotropic and analgesic agents for the purpose of anesthetizing labor.

After the introduction of scheme No. 1 or No. 2 after 2 hours with insufficient analgesic effect, the latter are combined with intravenous administration of 1000 mg of viadril. The viadril solution is prepared immediately before use - 500 mg of dry substance is dissolved in 10 ml of 0.25% -0.5% solution Novocaine (in one bottle, 500 mg of dry Viadryl substance). Viadryl is injected rapidly and furthermore to prevent phlebitis, it is advisable to introduce another 10 ml of novocaine (0.25% -0.5% solution). Sleep occurs in the first 5-10 minutes and on average lasts about 1-2 hours. With identical indications, sodium oxybutyrate can be added in an amount of 20 ml of a 20% solution. The action of the latter is in principle similar to the action of the viadryl. Anesthetic effect occurs in the first 10-15 minutes and lasts about 1 hour 30 minutes.

Anesthesia of normal birth: ataralgeznia (dilidolor + seduxen) in combination with halidor. In the presence of regular labor, opening of the uterine throat for 3-4 cm and pronounced painful sensations, giving birth in one syringe, intramuscularly injected 6 ml of a mixture containing 2 ml (15 mg) of dipidolor, 2 ml (10 mg) of seduxen and 2 ml 50 mg) of the halide.

When choosing different doses of seduksen and dipidolor, one should proceed from the psychosomatic state of the mother and the severity of pain. With significant psychomotor agitation, fear, anxiety, the dose of Seduxenum should be increased to 15-20 mg, and with the prevalence of painful labor, but without pronounced excitation, and even more so when the mother is depressed, the dose of Seduxenum can be reduced to 5 mg. The dose of halide is selected on the basis of the weight-bearing parameters of the parturient woman and is re-injected after 3-4 hours.

Repeated administration of seduxen and dipidolor with this method of anesthesia, as a rule, is not required. However, if the labor did not end in the next 4 hours, you can repeat the administration of the drugs in a half dose. For a faster and more pronounced effect of ataralgesia, drugs can be administered intravenously slowly at the same doses in a mixture with 15 ml of 0.9% sodium chloride solution or 5-40% glucose solution. The last introduction of the dipidor should be no later than 1 hour before the proposed start of the period of exile.

Clinical studies show that ataralgesia during normal delivery, using dipidolor, creates a state of mental rest, suppresses a sense of fear and anxiety, has an analgesic effect of sufficient strength and duration, is accompanied by stabilization of hemodynamic parameters. The parturients with ataralgesia doze between contractions, but are conscious and easily come into contact with the attendants.

The harmful effect of drugs for ataralgesia on the course of the birth act and the newborn has not been revealed.

Ataralgesia favorably affects a number of indicators in labor: for 5 h in primiparas and 3 times in mumps, the total length of labor is shortened, the rate of opening of the uterine throat is increased, the frequency of early discharge of amniotic fluid and the loss of blood in labor are reduced.

Neuroleptanalgesia (droperidol + fentanyl) in combination with antispasmodics. In the presence of regular labor and the opening of the uterine throat for at least 3-4 cm, a mixture of the following composition is injected intramuscularly into one syringe in a single syringe: droperidol 5-10 mg (2-4 ml) and fentanyl 0.1-0.2 mg (2-4 ml). Doses of droperidol and fentanyl should be selected (as well as the dipidolor and seduksen doses), based on the severity of pain and psychomotor agitation.

Repeated administration of droperidol should be applied through 2-3 h and discontinued no later than 1 h before the start of the expulsion period. The introduction of fentanyl must be repeated every 1-2 hours. Given the possibility of depressing effects of fentanyl on the respiratory center of the fetus, the last administration of the drug should be performed 1 hour before the expected delivery. Simultaneously with the administration of droperidol and fentanyl, a halide is prescribed in a dose of 50-100 mg. The same dose is repeated after 3-4 hours. The average single dose of droperidol was 0.1-0.15 mg per kg of body weight of the mother and the fentanyl 0.001-0.003 mg / kg. Anesthesia of normal genera by benzodiazepine derivatives (diazepam, seduxen) in combination with an analgesic - promedol.

For the same indications as in ataralgesia, in the presence of regular labor and opening of the uterine throat for 3-4 cm, 10 mg (2 ml) of seduxen diluted in 5 ml of isotonic sodium chloride solution are administered intravenously or intramuscularly. Seduxen should be administered slowly: for 1 minute - 1 ml of an ampoule preparation. With a faster administration, sometimes a mild dizziness, rapidly transient, diplopia can be observed in the parturient woman.

1 hour after the administration of seduxen, 20 or 40 mg of promedol solution is administered intramuscularly. The duration of analgesia with the combined use of seduksen and promedola lasts 2-3 hours. In this case, seduksen can not be administered either intravenously or intramuscularly in combination with other substances in one syringe. The total dose of Seduxen in childbirth should not exceed 40 mg intravenously or intramuscularly. This combination of substances does not adversely affect the maternity of the mother, the contractile activity of the uterus and the condition of the fetus and newborn.

Methods of applying the lexicon. Anesthesia of labor with a lexicon should be started when opening the uterine pharynx for 4-5 cm. The drug can be administered intramuscularly or (if necessary, get a quick effect) intravenously in a dose of 30-45 mg. Depending on the psychoemotional state of the woman in labor, it can be combined with seduksenom or droperidol. In all cases, it should be administered against the background of the action of antispasmodics (better halide in a dose of 50-100 mg). Repeated injections of the lexicon should be performed after 1-1 / 2 hours with a total dose of not more than 120 mg. The last injection is given no later than 1-1 1/2 hours before the end of labor. When applying the lexicon, the psychomotor reaction to the fight decreases, the tired mothers in the pauses between contractions doze. The lexicon has no negative effect on labor and fetus in this method of anesthesia. On the contrary, the duration of the disclosure period is somewhat shortened. However, if the last administration of the preparation coincides with the beginning of the period of exile, this negatively affects the effectiveness of attempts at the expense of weakening the reflex from the perineum.

The method of application of baralgina. In parturient women in the presence of sharply painful fights at the very beginning of the period of opening, it is recommended to use spasmoanalgesics - baralgin, 5 ml of a standard solution.

With the use of baralgina, along with the spasmolytic effect, there is also a marked and central analgesic effect. At the same time, the total duration of labor in the conditions of application of baralgina does not exceed 11 hours in the first and 9 hours in the re-birth. A detailed analysis of the course of the disclosure period showed that the use of baralgina leads to a shortening of the opening period by a factor of 2 in both the first and second-generation ones.

The use of baralgina in the miscarriages has a number of characteristics that physicians need to take into account in practical activities. Thus, the use of baralgina in re-births when opening the uterine pharynx by 5-6 cm leads to lengthening of labor for 1 h, and when the opening of the uterine pharynx is increased by 7 cm or more, a pronounced spasmolytic effect is again observed.

Abdominal decompression

For the purpose of pain relief during childbirth, some authors propose to influence the area of the Zakharyin-Ged skin zones with such physical factors: cold, heat, local vacuum.

In the 1960s, abdominal decompression, which in the first stage of labor resulted in a reduction or complete cessation of pain in 75-86% of parturient women, was proposed abroad for the purpose of anesthetizing and accelerating labor. The decompression technique is carried out as follows - slightly stretching the edges, the camera is placed on the maternity belly. Then, from the space between the walls of the chamber and the abdominal surface with the help of a compressor, air is evacuated during each contraction, reducing the pressure in the chamber by 50 mm Hg. Art. And support it between contractions at a level of 20 mm Hg. Art. For air evacuation, a surgical suction can be used, which within 6-8 s creates a vacuum in the chamber to 50 mm Hg. Art. The maximum duration of decompression with small interruptions was 3 hours. A good analgesic effect is observed in 51% of parturient women; with adequate behavior and reactions to pain, the analgesic effect reaches 75%, while in parturient women with marked psychomotor agitation, the presence of feelings of fear and others - only 25%. The contracting activity of the uterus in most parturient women is intensified. The method of abdominal decompression does not have a negative effect on the fetus, newborns and their development in subsequent days of life.

Electroanalgesia

Since 1968, Acad. L. S. Persianinov and E. M. Kastrubin developed a technique for electroanalgesia in labor with frontal-occipital overlapping of electrodes. At the same time, the therapeutic effect of electroanalgesia was obtained with a stepwise increase in the intensity of the current during the session, depending on the threshold sensations of the woman (an average of 1 mA). The duration of the session is 1-2 hours. After 40-60 minutes of exposure to pulsed currents between contractions, a drowsy condition is noted, and during a fight - a reduction in the pain reaction. In the presence of restless behavior with a predominance of neurosis, the electroanalgesia session is recommended to begin with the initial administration of pipolfen, dimedrol or promedol.

Anesthesia of ketamine delivery

1. The method of intramuscular injection. Ketamine is recommended for use in doses of 3-6 mg / kg of body weight, taking into account the individual sensitivity to it. The administration of the drug is started with 3 mg / kg, and one should not try to get a sleep: the woman in labor should undergo full anesthesia if there is a blockage, but does not interfere with contact with it. The following administration is performed after 25-30 minutes, and, if anesthesia is insufficient, the dose is increased by 1 mg / kg.

Do not exceed the amount of ketamine more than 6 mg / kg body weight; if in this case it is not possible to achieve satisfactory anesthesia, it is recommended to switch to the use of other methods of anesthesia. However, such situations are extremely rare, their frequency does not exceed 0.2%. The duration of anesthesia is chosen individually, based on a specific obstetric situation, the use of ketamine follows the general principles of drug-induced anesthetic delivery. The last administration of ketamine should be performed no less than 1 hour before the onset of the second stage of labor.

Additionally, it is always recommended to prescribe intravenously or intramuscularly 5-10 mg of Seduxen or 2.5-5.0 mg of droperidol to remove the "awakening reaction".

2. The method of intravenous administration. Intravenous administration of ketamine as a method of prolonged analgesia of labor is preferable because of its high manageability. After the administration of 5-10 mg of seduxen, a dropwise infusion of ketamine diluted with any plasma-substituting solution begins with an infusion rate of 0.2-0.3 mg / (kg-min). Complete anesthesia occurs most often in 4-8 minutes. Smoothly regulating the flow of anesthetic (best with the help of a perfusor), they achieve preservation of consciousness in the parturient woman with complete absence of pain sensitivity. As a rule, this can be done at a rate of drug intake of 0.05-0.15 mg / (kg x min). If there is no possibility of constant dynamic monitoring of the maternity status, it is recommended to use minimal amounts of ketamine with an infusion rate of 0.03-0.05 mg / (kg x min). This allows in most cases to achieve pronounced anesthesia and simultaneously carry out anesthesia in several parturient women. The intravenous method of drug administration makes it easy to control the level of anesthesia, the narcotic retardation of the parturient woman. Termination of the infusion immediately before the II period of labor allows the mother to participate actively in it.

The onset of anesthesia occurs without signs of excitation, and the characteristic hemodynamic changes, as a rule, disappear after 5-10 minutes from the beginning of administration of ketamine. There was no negative effect on the contractile activity of the uterus, the condition of the fetus and the newborn. Pathological hemorrhage or subsequent hypotonic bleeding is observed less frequently than usual.

However, sometimes the simplicity of conducting ketamine anesthesia is combined with a relatively long postoperative depression of consciousness requiring active monitoring of the patient, especially when using ketamine as an anesthetic aid in cesarean section, with small obstetric and gynecological operations (manual examination of the uterine cavity, suturing of perineal ruptures, ). Proceeding from this, the attempt of drug regulation of ketamine depression due to direct antinarcotics should be considered justified. With the use of the amine derivative of guatimine, its distinctive awakening effect was observed upon administration of large doses of sodium oxybutyrate. In addition, the inclusion in the immediate premedication of Seduxen and Droperidol did not solve the problem of post-operative hallucinosis: often the resulting motor-motor arousal creates difficulties for the care of patients.

Amtizol in a dose of 5-7 mg / kg body weight is used in the form of a 1.5% solution immediately after delivery of the woman from the operating room. The entire dose of the drug was administered intravenously at one time or in two divided doses at an interval of 1 hour (these were mostly women who had an urgent abdominal cesarean section and with ketamine analgesia), and amtisol was used to stop the anesthetic action of ketamine after short-term operations. As a criterion for the action of amtieol, psychological tests were used that can determine the rate of recovery of concentration of attention and the speed of reaction to a moving object. The following tests were applied: the reaction to the moving object, the ratio of the rate of the delay response to the advancing reactions, the critical frequency of flashing by both eyes, separately the right and left, the total separate mean frequency of flashes and the difference reflecting the disparity of the nervous processes in the left and right hemispheres of the brain positive for the right. Tests were repeated every 10-15 minutes until the initial reactions were restored to the administration of ketamine. It has been established that the spontaneous resolution of post-amniotic depression for the administration of 100-120 mg of ketamine occurs only in the 75th - 80th minute. Against the background of amityol, the complete restoration of the concentration of attention and reaction speed to a moving object occurs 4-5 times faster. Moreover, the reaction to the moving object against the background of the administration of amtisol is even accelerated. At the same time, with spontaneous resolution of consciousness depression for the administration of 120 mg of ketamine, even after 80 minutes, it is 1.5 times slower than the baseline level. Under the same circumstances, the ratio of delayed reactions to those advancing is much less than before ketamine anesthesia. Thus, the derivative of guhtimine - amtizole has a distinct positive effect on the processes of recovery of consciousness and significantly reduces the hallucinogenic manifestations in the depression of consciousness after prolonged anesthesia with the use of ketamine. The effect of amtisol against the background of a stable state of vital functions is not combined with stimulation or depression of respiration and hemodynamics. Its antinarcotic effect, apparently, has a predominantly central genesis, since amtizol is a drug of central nonspecific action. Termination of the anesthetic effect of a single dose of ketamine in 100-200 mg after administration of amtisol at a dose of 3 mg / kg body weight allows the use of ketamine and for short-term operations (no more than 10 minutes).

Anesthesia of complicated labor in women in labor with toxicosis of the second half of pregnancy

In parturient women with late toxicosis, a combination of psycho-preventive preparation of pregnant women for childbirth and medical anesthesia of childbirth is necessary, as the absence of anesthesia in them, as is known, can lead to deterioration in the maternity and fetus status.

Methods of analgesia of childbirth. Swelling of the pregnant.

With regular labor and opening of the uterine pharynx for 2-4 cm intramuscularly in the same syringe, the following substances are administered: a 25 mg propazine; dimedrol - 40 mg or pipolfen - 50 mg; promedol - 20 mg; dibazol (in a separate syringe) - 40 mg.

In parturient women with hypertensive form of late toxicosis - diprasine in a dose of 50 mg or pifolphin - 50 mg; propazine - 25 mg; promedol - 20 mg; Pentamine - 25-50 mg or droperidol 3-4 ml (7.5-10 mg); fentanyl - 2-4 ml (0.1-0.2 mg). At the same time, women with swelling of the pregnant women are prescribed spasmolytic - gang-gleron - 30 mg intramuscularly, and with hypergensic forms of late toxicosis - spasmolithine in a dose of 100 mg.

To increase analgesia or self-use autoanalgesia for women with swelling of pregnant women - trichlorethylene in a concentration of 0.5% by volume, methoxyflurane - 0.4-0.8%, ether - 1%, nitrous oxide with oxygen in a ratio of 3: 1, and Women with hypergenic forms of late toxicosis - fluorotane in a concentration of 1% by volume. In addition, when entering the maternity department, women with hypertensive form of late toxicosis are prescribed tranquilizers - nosepam 0.01 g (1 tablet) or diazepam - 15 mg orally in combination with spasmolytic, which has a central sedative and spasmolytic effect.

With nephropathy of the third degree and pre-eclampsia. Along with the therapy of late toxicosis, when a woman enters the maternity ward, diazepam is administered intramuscularly in a dose of 10 mg or droperidol also in a dose of 10 mg.

In the presence of painful fights intramuscularly administered a combination of propazine, pifolen, promedola, pentamine in the above doses. In the presence of high blood pressure, the introduction of pentamine can be repeated at intervals of 1-2 hours at a dose of 50 mg, intramuscularly under the control of blood pressure up to 3-4 times during the birth act.

Anesthesia of childbirth does not exclude the use of specific methods for the treatment of late toxicosis.

Anesthesia of childbirth in certain diseases of the cardiovascular system

In hypertensive patients, women with tranquilizers are prescribed for admission: nosepam 0.01-0.02 g inwards and spasmolytics - spasmolithine - 100 mg inwards and intramuscularly with 2 ml of a 2% solution of dibazol.

In the presence of regular labor and the opening of the uterine pharynx for 2-4 cm, the following combination of drugs is introduced: aminazine 25 mg, promedol 20 mg, pentamine 25 mg, ganglerone 30 mg intramuscularly in one syringe. To increase analgesia, inhalational anesthetics are used - trichlorethylene in a concentration of 0.5-0.7% by volume and fluorotane 0.5-1.0% by volume.

Births with hypotension

At admission appoint tranquilizers - nosepam on 0,01 g (1 tablet) inside.

For analgesia of childbirth, the following combination of substances is administered: inside spasmolithine in a dose of 100 mg; intramuscular promedol - 20 mg; dimedrol - 30 mg; Diprazine (pipolfen) - 25 mg.

To increase analgesia, use nitrous oxide with oxygen in a ratio of 2: 1.

Microfusion of clonidine in labor

The problem of treatment of arterial hypertension in childbirth remains relevant in practical obstetrics. Promising to recognize the funds that promote in small doses of activation of certain central adrenergic structures and significantly affect both the circulatory system and the regulation of pain sensitivity. One of these drugs is clonidine, which, along with a pronounced hypotensive effect and a clear analgesic effect, and in minimal therapeutic doses. The use of clonidine is complicated to some extent by the difficulty of selecting the optimal dose, as well as the possibility of developing diverse hemodynamic reactions, which is especially important in the treatment of pregnant and parturient women with hypertensive forms of toxicosis, which have significant disorders of microcirculation, organ and systemic circulation.

The obtained clinical data confirm that clonidine is an effective antihypertensive agent and has a clear analgesic effect. If the severity of the hypotensive effect is directly proportional to the applied doses of the drug, the analgesic effect is the same in a wide range of doses.

The use of perfusion clonidine in labor with a velocity of 0.0010-0.0013 mg / (kg h) leads to a decrease in arterial pressure by an average of 15-20 mm Hg. Art. Due to a certain decrease in the systemic arterial tone with the invariance of other indices of the central hemodynamics of the parturient woman. Negative effects on the contractile activity of the uterus and the state of the intrauterine fetus have not been noted. When clonidine is used in the form of intravenous perfusion at a rate of 0.0010-0.0013 mg / kg / h, satisfactory anesthesia and a moderate hypotensive effect are achieved.

Compensated heart disease

When you give birth to a maternity ward, tranquilizers are prescribed - nosepam - 0.01 g (1 tablet) or phenazepam - 0.0005 g (1 tablet) inside and carry out appropriate cardiac therapy as needed. Intramuscularly, the following combination of substances is administered in one syringe: 50 mg of pilofen, 20 mg of promedol, 30 mg of gangleron, and 25 mg of propazine.

Decompensated heart disease and myocardial dystrophy

Assign tranquilizers and cardiac therapy. Intramuscularly in the same syringe, the following combination of drugs is administered: pipolfen in a dose of 50 mg, promedol - 20 mg, gangleron - 30 mg. To increase analgesia or self-autoanealgesia using nitrous oxide + oxygen in a ratio of 3: 1 or 2: 1.

[1], [2], [3], [4]