Quite often, it becomes necessary to use medical anesthesia during labor. Experience has shown the expediency of combining psycho-physical preparation with pharmacological methods of anesthesia.
Drugs are almost always prescribed to women in labor who have not undergone psycho prophylactic preparation, when there is no proper effect from it, or with complicated births.
In 1936 O.Yu. Lurie for the first time in Ukraine applied mass maternity anesthesia in maternity hospitals. At this time, the anesthesia regimens of labor were developed.
Obstetrical anesthesia has its own peculiarities:
1. Obstetric anesthesia, basically, should last many hours.
2. Obstetrical anesthesia (especially in the 1 st and 2 nd periods) should not be too deep and not cause significant relaxation of the uterus musculature.
3. Obstetric anesthesia should also take into account the interests of the fetus.
Ideal that these requirements are epidural anesthesia, which does not cause pathological changes in the fetal condition, allows complete contact with the rhodium and does not relax, and also normalizes the contractile activity of the uterus. But this kind of anesthesia has not yet been widely used in all institutions, because this manipulation should be carried out by a specially trained anesthesiologist.
Now there are many methods and methods of anesthesia of the birth. . Only it is necessary to use them correctly taking into account the period of childbirth, the condition of the mother and the fetus.
In the first stage of labor: with tranquilizers (trioxazine 300-600 mg, diazepam 5-10 mg, or phenazepam, 00005 grams inwards in combination with antispasmodic (100 mg), suggest tranquilizers with a feeling of fear, emotional and mental stress. regular labor and cervical dilatation at least 3-4cm, and finish by the end of the disclosure period. Women with normal excitability against the background of tranquilizers are administered intramuscularly propazine hydrochloride 25 mg with 20 mg promedol and 25 mg of diphenhydramine in 5 mg 0.5% p Novocaine azvor or 25 mg propazine (25% -1ml) + pipopolen 50mg (2.5% -2ml) + promedol 20 mg (2% -1ml) .Workers, with sharply painful bouts, from the very beginning recommend antispasmodics (baralgin 5ml), women with high excitability are given maximal doses of trioxazine (20 mg per 1 kg of weight) or seduxen (10 mg orally with 20 mg of promedol and 25 mg of aminazine) or 25 mg of aminazine (2.5% to 1 ml), pipolfen 50 mg (2.5% - 2 ml), promedol 20 mg (2% - 1 ml). If the analgesic effect is inadequate, atropine (0.1% - 1 ml) or no-shpa (2 ml) and a half dose of the drug of one of the above schemes are prescribed 2-3 hours after the start of the injection.
In case of rigidity of the cervix, chewing is done with Novocain solution (20 ml -0.5%) together with Lidase (64OD), Atropine (0.1% -1ml) or no-spike (2ml). You can also use: liqueurs (papaverine 002 + krasavki extract 002 g + wine alcohol - 15.0 + syrup - 20.0). Painkillers (krasavka extract 002 + papaverine 002 + amnopone 002 + antipyrine 0.5 + atropine 0003). Analgesic microclysters (promedol 001 + Na bromide 2.0 + novocaine 0.1 + proserine 0003 + water - 45ml).
In the I-st labor period you can use:
- Anesthesia of reflex zones 05 - 025% solution of novocaine with lidase (in cervical node). Widely used antispasmodics (every 2 - 4 hours);
- Rectal suppositories, which contain an extract of belladonna 003 pantopone 002 amidopyrine 0.5. Candles are injected into the rectum at the beginning of the opening period and again after 3-4 hours;
- Intramuscularly: pantopone solution 2% - 1 ml together with a solution of magnesium sulphate 25% - 5 ml; trigan - 5ml; maxigan - 5ml; spazgan - 5ml; baralgin - 5 ml, solution droperidol 2.5% - 2ml. Solutions are re-introduced after 3-4 hours;
- subcutaneously solution of promedol 2% - 1-2ml, solution of tecodyne 1% -1ml, solution of aprofen 1% -1ml;
- Intravenous drugs: sodium oxybutyrate solution 20% (50-70 mg /kg) vidryl 500 mg;
- Narcotic inhalation means: nitrous oxide in a mixture with oxygen (80% of nitrous oxide 20% of oxygen) with the help of a special device, which can be used by the woman in childbirth. Trichlorethylene can be used in the same way.
In the second period of labor, nitrous oxide (at the beginning) can be used. In addition, pudendalna is used for anesthesia: 60-70 ml of 025% solution of novocaine is injected into both ischiorectal spaces on both sides, which is 1-2 cm medial from the ischial hillock. The essence of the method is the blockage of the branches of the shamed nerve.
This method gives anesthesia and causes the spasmolytic effect of the pelvic floor muscles, therefore, it should always be used during labor in the breech presentation, premature birth, birth of a large fetus to prevent injuries to both the mother and the fetus. It is important for 2 hours before the nation's child, to stop the introduction of the mother of the pharmacological means, which in different degrees can cause a depressive effect on the fetus and the newborn.
For surgical interventions after the fetal expulsion in the third stage of labor and the early postpartum period (manual examination of the uterine cavity and separation of the placenta, rupture, etc.), sodium thiopental 4-5 mg /kg, intravenously sombrevine 8-10 mg /kg of weight, ketalar 2 mg /kg, etheric and will turn into an inhalation anesthesia.