Spinal anesthesia during a caesarean section
introduction
One third of children in Germany are born through a caesarean section. This is a special situation because when choosing the anesthetic method, both the effects on the mother and the effects on the child must be taken into account.
In addition to general anesthesia, a caesarean section can also be performed under regional anesthesia close to the spinal cord. These include epidural anesthesia and spinal anesthesia. Both are considered safe anesthetic procedures that ensure optimal pain relief during the caesarean section. With spinal anesthesia, the lower half of the body is anesthetized by injecting anesthetic into the spinal canal (spinal canal). During the caesarean section, the mother is conscious but does not feel any pain and cannot move in the lower half of the body. Sometimes the feeling of pressure is partially retained, so that it is felt that something is being done, but no pain is felt. A sedative can be taken to subdue consciousness. Many clinics offer mothers the option of listening to music through headphones during the procedure in order to shield themselves from the noises in the operating room.
Spinal anesthesia sequence
In the channel that within the spine runs, the Spinal canal, are located Nerve water, the Spinal cord, as well as those from the spinal cord outgoing nerve fibers. The spinal cord ends approximately at the level of the first lumbar vertebra, only nerve fibers run underneath. In order not to injure the spinal cord, a Spinal anesthesia between the 3rd and 4th lumbar vertebrae or between 4th and 5th lumbar vertebrae carried out.
The best should be Mother sitting and one Hunchback ("Katzenbuckel"), alternatively the spinal anesthesia also in the side position respectively. First there is a local anesthesia. Then a thin needle in the space between two vertebral bodies Introduced through the skin of the spinal cord (dura). If the needle hits nerve fibers, these are able to Dodging the needleso that injuries do not normally occur. As an extra precaution, the The tips of the special needles are rounded. In the space filled with nerve water this will now Injected anesthetic. Due to the special properties of the anesthetic used, the body position and the puncture height, it is distributed predominantly in the lower area of the spinal canalso that only the lower half of the body is stunned. When injected, it can be immediate Tingling or heavy legs come. Immediately afterwards the needle is pulled out again. One can imagine that the nerves that conduct pain are from Washed around pain medication and so the transmission of pain is blocked. The effect of spinal anesthesia sets in quickly and lasts about 3-4 hours.
When is spinal anesthesia used?
The choice of Type of anesthesia with depends mainly on the Urgency and reason for the caesarean section, as well as the Mother's wish from. Spinal anesthesia is mostly used planned and urgent caesarean sections, in which the child is to be delivered within a period of half an hour. During the emergency caesarean section there is one Danger to mother or child in front. Since the caesarean section should take place here as quickly as possible, due to the immediate onset of action, a General anesthesia selected.
Certain diseases of the mother speak against spinal anesthesia during a caesarean section, such as Blood clotting disordersassociated with a tendency to bleed. Infections, shock and increased intracranial pressure are also considered contraindications for performing a caesarean section under spinal anesthesia. Spinal anesthesia may not be performed in the case certain malformations or injuries to the spine mother. Even with certain Cardiovascular disease and Central nervous system disorders Spinal anesthesia is not recommended.
The choice of anesthetic method should be general after detailed consultation be decided individually by the anesthetist and weighing up the benefits and risks. The Basic requirement for performing spinal anesthesia is the Cooperation of the motherbecause their active cooperation is necessary. Does it get too strong during spinal anesthesia nausea or dizziness or to extreme fear and excitement, one can Change to general anesthesia become necessary. General anesthesia may also be necessary during the procedure if breathing difficulties, surgical problems or unexpected pain occur. Therefore, the anesthetist is always prepared to perform general anesthesia in the event of problems.
advantages
The spinal anesthesia is considered to be simple and very reliable technology in general and also with caesarean section. she is can be carried out quickly, the effect sets in after a short time and switches the sensation of pain in the lower body for 3-4 hours out. The choice of spinal anesthesia for caesarean section allows the mother to do so birth consciously experiencing your child. she is awake, breathing by yourself and feeling no pain. The Muscles the lower half of the body are paralyzed by the anesthetic. In the case of a caesarean section performed under spinal anesthesia, the Father usually also there so that the mother has support by her side. By keeping the mother going during the procedure not in a drug-induced deep sleep many of the risks associated with general anesthesia can be avoided. Unlike general anesthesia, the child is not burdened with anesthetic drugs. Overall, spinal anesthesia is one for mother and child Low-complication anesthetic method. Some studies suggest that anesthesia procedures close to the spinal cord, such as spinal anesthesia, mean greater safety for mother and child during caesarean sections. Therefore, the spinal anesthesia should be used, unless otherwise indicated preferred to a caesarean section over general anesthesia become.
Risks of spinal anesthesia
As with any physical procedure, also with spinal anesthesia Infection at the injection site, bleeding, and nerve damage possible risks. Typical side effects are a Drop in blood pressurebecause the narcotic the Vessels in the lower body expanded so that temporarily too a lot of blood in the legs falls off. However, this is monitored by the anesthetist and carried out quickly in the event of a drop in blood pressure Injecting a drug treated.
Other side effects that can occur after spinal anesthesia are Nausea and vomiting. Also Backache and headache can occur. The headaches are usually most severe while standing and disappear when lying down. After the spinal anesthesia has subsided, it can briefly Urinary bladder dysfunction come. As soon as the spinal anesthesia has completely subsided, it automatically returns to normal. The dreaded complication of spinal anesthesia is one Paraplegia from injury to the spinal cord. This is nowadays extremely rare, because the injection takes place below the spinal cord in an area in which only individual nerve fibers run. These nerve fibers have the ability to Dodge the needle to be able to. The tip of the special needles is rounded so that the risk of injury is minimal.
Side effects
Although spinal anesthesia means that the person is conscious during the procedure, some side effects are still possible. First of all, there is the possibility of intolerance to the drugs used.
In addition, the drugs often have a depressant effect on the circulatory system and are also accompanied by nausea and dizziness. However, these side effects can be controlled and alleviated directly with other medication.
Serious complications can occur if the drugs get into blood vessels because the concentration is too high and a central effect on the circulatory system is triggered.
Headache can occur after spinal anesthesia. This happens because small amounts of brain water escape during the puncture, creating a pull on the brain. These headaches usually resolve quickly and are otherwise easy to treat. A bruise can also form at the injection site, which is sensitive to pressure for a few days.
Many women need a urinary catheter for a short time after a caesarean section with spinal anesthesia, because the control of the bladder function does not work normally. In rare cases, a purulent abscess also forms at the injection site.
Read more on the topic:
- Complications from spinal anesthesia
- Long-term effects of spinal anesthesia
What are the alternatives
In addition to spinal anesthesia, there is an alternative to general anesthesia or epidural anesthesia. The epidural anesthesia is very similar to the spinal anesthesia. However, the anesthetized area is less and it is not a single administration of the drug, but rather a continuous administration via a tube into the lumbar vertebral canal. General anesthesia is usually an option for emergency births. However, this anesthetic is associated with greater risks and also reaches the child, which can be a bit sleepy after the birth.
Read more on the topic:
- Anesthesia during pregnancy - important information
- Epidural anesthesia - implementation and complications
- How can you relieve birth pains?
Epidural anesthesia (PDA)
PDA is the abbreviation for epidural anesthesia. This is a regional anesthetic similar to spinal anesthesia. The Dura is one of the membranes of the spinal cord and the anesthetic is injected around the membrane of the spinal cord in the lumbar region. The nerves that supply the uterus and the abdomen run in this region. These are numbed by the anesthetic.
During the epidural anesthesia, a small tube remains in this epidural space. The anesthetic can be adjusted more individually than with a single dose with spinal anesthesia.
However, this hose does not only have advantages. Like all foreign bodies that are introduced into the body, this access forms an entry point for bacteria. Infections in this area are dangerous because there is a direct connection between the membranes of the spinal cord, the meninges and the brain. The PDA does not pose any relevant risks for the child, since it does not come into contact with the anesthetic. The PDA is also used to relieve pain in natural births and not just in caesarean sections.
Read more on the topic: Epidural Anesthesia - Procedure and Complications
general anesthetic
General anesthesia is a major intervention in the body and is therefore not the first choice for a planned caesarean section. In emergency births, however, a caesarean section is often used as this is the fastest option. The expectant mother's consciousness and pain sensation are completely switched off and the birth is not consciously perceived.
Medicines are given that act centrally and on the entire body. Since the muscles are also switched off, ventilation via a ventilation tube is necessary. The blood pressure, heart rate and breathing are checked and controlled by the anesthetist. After the anesthesia, the mother is still weakened for some time and cannot directly take care of her newborn.
Overall, general anesthesia is associated with a greater risk of complications. For the child, too, this method is a more powerful intervention in the body, as it absorbs some of the medication via the umbilical cord and appears somewhat sleepy after the birth. In most hospitals, the partner cannot go into the operating room.
Read more on the topic:
- General anesthesia - procedure, risks and side effects
- Anesthesia during pregnancy - important information
- Wake up time after general anesthesia
How do I deal with the fear of spinal anesthesia
Fear of a medical intervention and also of the birth itself are completely normal and above all a fear of the unknown. Many women find it helpful to talk to other women and their midwife and the treating doctors and to clarify all questions. In the case of spinal anesthesia, the partner can usually also go into the operating room and can therefore support the woman. Fears should be addressed openly. If the fear of spinal anesthesia is too great, alternatives can be considered.
