Names of drugs for anesthesia in gynecology. Features of abortion. Sedation and intravenous analgesia

Carrying out minor gynecological operations (artificial termination of pregnancy, diagnostic curettage, etc.) without pain relief can cause unwanted changes in vital important systems body. Described deaths painful shock when the cervix dilates. Irritation of highly sensitive reflexogenic zones uterus in the process of dilation of the cervix, removal ovum and contractions of the uterine muscles cause a flow of afferent pain impulses.

Painkillers that can be used during minor gynecological operations must meet the following requirements:
. ensure rapid onset of anesthesia;
. provide adequate pain relief throughout the entire period of surgery;
. cause retrograde amnesia;
. have a wide therapeutic range;
. quickly eliminated from the body;
. do not have a pronounced negative impact on vital important organs and systems;
. do not suppress the contractile activity of the uterus.

Anesthesia for minor gynecological operations can be used both in the form of general and local anesthesia. The latter should be done using modern local anesthetics against the background of adequate premedication.

For short-term anesthesia, it is necessary that the operating room has everything necessary to provide emergency anesthesia and resuscitation care in case of sudden development of complications of anesthesia (collapse, anaphylactic shock, aspiration syndrome, etc.).

Inhalation and intravenous anesthesia should be performed by an anesthesiologist-resuscitator. After awakening the woman and restoring verbal contact with her independent transition The patient is not allowed into the ward; transportation is carried out on a gurney.

Exist following methods anesthesia for minor gynecological operations:

General inhalation anesthesia(nitrous oxide, fluorotane);
. general intravenous anesthesia (propofol, ketamine, their combination, anesthetics, barbiturates);
. local anesthesia (paracervical).

Nitrous oxide in combination with oxygen does not always provide the required degree of analgesia. When the canal expands, for most women the pain is not completely relieved. In this case, motor agitation may occur, which complicates the course of the operation and anesthesia. Depending on body weight and psycho emotional state Women can use the tranquilizer diazepam (Seduxen) for premedication. In cases of severe agitation, the drug can be administered intravenously. For premedication, the neuroleptic droperidol is also used, which is usually administered intramuscularly 30-60 minutes before surgery at a dose of 2.5-5 mg (1-2 ml of 0.25% solution).

Inhalational analgesia with nitrous oxide . Sometimes there may be vomiting during the awakening period.

Short-term fluorotane anesthesia admissible only as an exception, for special indications. These include hypertonic disease, bronchial asthma with unstable remission, excessive vomiting in early toxicosis, contraindications to the use of other anesthetics, in particular, individual intolerance. Ftorotan is a powerful anesthetic agent whose action is characterized by a short analgesic phase. The anesthetic has a pronounced relaxing effect on the uterus, so the danger increases hypotonic bleeding, especially when the pregnancy is more than 12 weeks.

General intravenous anesthesia
Adequate anesthesia when performing medical abortion is carried out with calypsol (1-1.2 mg/kg body weight), diprivan (4-8 mcg/ml) or a combination of diprivan with microdoses of fentanipe (0.05-0.025 mg) and calypsol (2.5-12.5 mg). This combination ensures a stable course of anesthesia without significant hemodynamic disturbances. With more later(more than 12 weeks) non-inhalational anesthesia is maintained by inhalation of nitrous oxide and oxygen in a ratio of 1:3. Similar anesthesia is performed with diagnostic curettage uterus, with hysteroscopy.

For pain relief during artificial termination of pregnancy, a subnarcotic dose (1 - 1.5 mg/kg) of ketamine with 5-10 mg of seduxen in 5-10 ml is administered intravenously isotonic solution sodium chloride.

Paracervical anesthesia carried out as follows. The cervix is exposed with speculums and taken with bullet forceps. 15-20 ml of 0.25% novocaine solution is injected into the paracervical tissue through the lateral fornix using a long needle. After 1-2 minutes, you can begin to expand the cervical canal. The use of paracervical anesthesia is acceptable in women with high threshold pain sensitivity, respiratory tract diseases, if the patient refuses general anesthesia.

Choosing a method of pain relief if available extragenital diseases individual depending on the woman’s condition.

Intravenous anesthesia is used everywhere today for short-term gynecological and surgical operations. The duration of such surgical interventions should not exceed 10-15 minutes. The analgesic effect occurs a maximum of a minute after the administration of narcotic substances.

Indications for intravenous anesthesia

Used in gynecology this type general, as well as with the following manipulations:

Suturing of soft tissues in case of rupture of the birth canal;
Application of obstetric forceps;
Manual separation of the placenta and discharge of the placenta;
Curettage of the uterus in the postpartum period;
Manual examination of the uterine cavity and other indications.

In addition to gynecology, intravenous anesthesia is used in other areas of medicine for the following indications:

Correction of dislocations;
Electropulse therapy;
Splinting the injured limb;
Tracheal intubation.

Ketamine use

This drug is primarily used for intravenous pain relief. The main feature of this analgesic is imminent attack narcotic effect (40 seconds after administration). The effect of ketamine lasts 10 minutes, while the patient is in a state where some areas of the brain are depressed and others are excited. During sleep there are the following indicators: pulse quickens; cardiac index increases; cardiac output increases; blood pressure rises.

This analgesic is contraindicated for women in labor and pregnant women with severe forms of gestosis (a syndrome manifested by pathological increase body weight, edema, and so on), as well as those with a labile psyche (characterized by extreme mood variability, unpredictable switching of emotional state). Other contraindications for the use of ketamine include:

Cerebrovascular accident;
Epilepsy;
Severe hypertension ( high blood pressure on one of the sections of the circulatory system);
Eclampsia with severe violations normal blood circulation.

The undeniable advantage of ketamine is its negligible effect on the child and fetus. In addition, ketamine anesthesia relaxes the bronchial musculature and improves pulmonary blood flow, making it the most suitable option for patients with a history of various diseases bronchi.

The consequences of using anesthesia with ketamine include the following unpleasant moments:

Involuntary movements of arms and legs;
Hallucinations;
Bad dreams;
Delirium (impaired consciousness).

Use of sombrevin

Intravenous anesthesia with the use of this anesthetic is rarely used, the reason for this was the numerous consequences of the use of sombrevin. Here are some of them:

Convulsions;
Decline blood pressure more than 20%;
Motor excitement;
Anaphylactic shock;
Bronchiolospasm;
Hives;
Heart failure;
Hypotony of the uterus and more.

As you can see, the consequences of using sombrevin are very serious, so preference should be given to either other narcotic drugs or another type, for example.

Use of barbiturates

Such narcotic drugs include sodium thiopental and hexenal. The effect of the drugs after intravascular administration lasts about 20 minutes. In order to prepare a solution of barbiturates, mix 1 gram of the drug with 100 ml of 1% sodium chloride solution. The resulting solution is injected at a rate of 1 ml in 10 seconds. After administering three milliliters of the product medical staff determines the patient's sensitivity to barbiturates. Further, its intravascular administration continues until complete anesthesia.

Advice: for this type intravenous anesthesia characterized by respiratory depression, so the presence breathing apparatus in the operating room a prerequisite.

Indications for the use of barbiturates include such surgical interventions as opening abscesses, repositioning bone fragments, reducing dislocations, phlegmon (acute purulent inflammation). In addition, indications for the use of barbiturates are convulsive syndrome with tetanus, cocaine overdose, status epilepticus.

Using viadril

It is recommended that this drug be administered slowly into central vein in the form of a 2.5% solution. Viadryl is considered a difficult anesthetic to control, which is why it is used simultaneously with nitrous oxide. The use of Viadril is complicated by some of its consequences. These consequences include the development of thrombophlebitis (formation of blood clots).

Contraindications to intravenous anesthesia

Inflammatory diseases of the nasopharynx;
Severe heart failure;
Pregnancy;
Severe kidney and liver failure;
Allergic reactions.

Despite some consequences of using intravenous anesthesia, it is more acceptable compared to inhalation anesthesia. Its main advantages are the onset of an analgesic effect within a moment after the administration of anesthetics, as well as the convenience of induction and the absence of the need to use complex medical equipment. Research is currently underway to improve narcotic drugs for intravenous anesthesia, which will avoid many negative consequences its application.

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Common gynecological operations are uterine curettage and abortion. Patients come under the care of surgeons at the age of 25-35 years, without having concomitant diseases. The choice of type of anesthesia in gynecology determines the type of operation performed.

General principles of pain management

There are time-tested principles that gynecological specialists apply to perform surgical interventions of varying complexity.

To ensure complete pain relief and favorable rehabilitation period complex anesthesia with novocaine blockade is used. When choosing an anesthesia, take into account the nature of the disease, general state patient, her age characteristics, as well as work nervous system. Stages of anesthesia in gynecology:

blackout;
liquidation reflex reactions body to external influences;
muscle relaxation to ensure conditions for the operation;
regulation of blood circulation and breathing.

Anesthesia should not be dangerous for the functioning of the nervous system and should create favorable conditions for intervention.

Types of anesthesia

When performing gynecological operations, one of four types of anesthesia is used - general, local anesthesia, sedation, regional anesthesia.

For short-term operations such as puncture posterior arch, curettage of the uterine cavity or abortion, sedation or local anesthesia is sufficient, and for extensive cases general and sometimes epidural anesthesia is used.

Local anesthesia

Pain relief involves pre-treatment tissues around the cervix with a local anesthetic - lidocaine or novocaine, to block painful sensations during uterine manipulations.

To prevent the ingestion of anesthetic blood vessels Gynecologists perform interventions under anesthesia, similar to sedation.

Sedation and intravenous analgesia

Sedation in gynecology is the administration of a tranquilizer drug intramuscularly to reduce anxiety, as well as fear, but not pain, or the administration of an analgesic that dulls pain, but not emotional sensations during surgery.

Intravenous anesthesia - type general anesthesia, induces sleep during surgery and dulls pain.

Anesthesia for abortion

Girls going for an abortion do not know what awaits them. There are clinics where fetuses are still removed without pain relief.

Types of anesthesia used by gynecology workers during abortion:

local;
sedation;
general.

At vacuum cleaning Obstetricians prefer to use local anesthesia, but the patient experiences discomfort and sometimes mild painful sensations. The anesthetic solution is injected through the walls of the vagina to the cervix, and therefore there is a risk of it getting under the walls of blood vessels, resulting in convulsions with loss of consciousness.

Sometimes doctors use general anesthesia or sedation. General anesthesia – deep dream, caused medications, and sedation is the same sleep, but superficial. During shallow sleep, the woman feels pain, but after the procedure she forgets it.

Drugs used to artificially induce sleep are non-inhalational anesthetics midazolam, propofol, the opioid fentanyl, ketamine. The latter is rarely used due to its hallucinogenic properties and effects on long-term memory.

Indications for abortion:

the patient’s desire until the 12th week of fetal development;
heart disease;
diseases of the lungs and respiratory tract;
liver and kidney diseases;
circulatory disorders;
tumors;
psychiatric spectrum disorders.

Curettage of the uterine cavity

Curettage of the uterus is used for bleeding, abortion or the formation of polyps. Anesthesia for gynecological operations is prescribed by an anesthesiologist, and local anesthesia or sedation drugs are administered by a gynecologist. The duration of the procedure is on average 15 minutes.

During sedation for the purpose of curettage, the doctor administers narcotic painkillers or tranquilizers intravenously in moderate doses. There is a risk of causing breathing problems for the patient during surgery by overdosing.

Local anesthesia does not require preparation - it dulls pain during the surgeon’s surgical procedures, but does not completely block it.

General anesthesia in gynecology is performed intravenously while maintaining spontaneous breathing, due to the short duration of the procedure and the inability of stomach contents to enter the lungs. General anesthesia drugs: thiopental, ketamine, propofol.

Removal of the uterus under anesthesia

For the anesthesiologist, the type of operation does not matter: removal, amputation, hysterectomy. With these surgical interventions, depending on the initial condition of the patient, age, urgency of the operation, a combined multicomponent anesthesia with relaxants, or spinal or epidural anesthesia is performed.

Amputation and extirpation of the uterus are performed under general or epidural anesthesia, focusing on the urgency of the operation and the patient’s condition. For abdominal surgery lasting more than two hours, removal is carried out under general anesthesia, and for short-term vaginal manipulations - under spinal or epidural anesthesia.

Benefits of regional anesthesia:

comes quickly;
the abdominal muscles relax after administration of the drug;
Epidural anesthesia can treat pain from surgery.

Inhalation administration of drugs

Inhalation anesthesia is a type of general anesthesia. In gynecology, it is performed using nitrous oxide or ether for short-term minimally invasive operations to eliminate condylomas or polyps, as well as when necessary to diagnose the condition of internal organs.

Deep oxygen-ether anesthesia is administered using an inhalation face mask as an alternative to endotrache and endotrache. Its disadvantages are the likelihood of respiratory arrest, as well as a long process postoperative rehabilitation with nausea, vomiting, headache and related symptoms.

Spinal anesthesia

In gynecology and in surgery in general, there are different types of spinal anesthesia: spinal, spinal, epidural, epidural, sacral = caudal - essentially almost similar techniques, the anesthetic is injected into the subarachnoid space! Or lower between 4-5 vertebrae, where the spinal cord itself ends and the continuation begins spinal cord- Cauda equina – so-called. ponytail.

Spinal cord is used for conditions with low blood pressure. Active ingredient– novocaine solution 4-5%. It is injected into the subarachnoid space using a syringe. Risk of any manipulation in the area spinal canal– reduction blood pressure(sometimes significant) or the occurrence of tabloid paralysis - in good hands a doctor is extremely rare! Drugs - lidocaine, bupivacaine and ropivacaine and analogues.

Epidural anesthesia is administered to the patient while sitting between the second and third lumbar vertebrae. Contraindications: diseases of the central nervous system, injuries, deformities of the spinal column.

Sacral = caudal anesthesia - in gynecology, it is injected into the sacral area while lying down and is widely used for operations below the navel, on the perineum and anorectal area, for example, hemorrhoids.

Professional anesthesiologists in gynecology rarely make mistakes in choosing the dosage of an anesthetic drug, so you should trust them with your health.

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Questions on the topic

Anna 05/20/2018 15:05

Hello. My sister is about to have an endometrial polyp removed. She uses amphetamine. Is this a contraindication for anesthesia?

Elena 03/10/2017 19:59

Good afternoon, we are undergoing hysteroscopy with taking scrapings from the endometrium for analysis to diagnose an oncological process, diagnosis - acyclic bleeding, endometriosis. Nowhere in the capital of Ukraine did I find the opportunity to hold it under local anesthesia+ sedation, 46 years old, chronic pathologies no, blood pressure is normal with a tendency to be low, but there is a history of bipolar disorder, panic attacks, extremely difficult recovery from IV ketamine anesthesia. Thiopental or propofol are recommended. Tell me where in the Russian Federation you can conduct under local anesthesia or other type of diagnosis (without biopsy). Thank you in advance!

Katya 01/15/2017 10:52

Good afternoon. Very soon I will have to go through the verification procedure fallopian tubes under sedation. I’m incredibly worried because I’ve never used this type of anesthesia, but I categorically refuse to do it without it, I’m so afraid, even in advance. Tell me, how common is such anesthesia in this type of procedure now? For some reason, many people do it without, but my doctor at the clinic claims that it is necessary.

Anesthesia (general anesthesia) is an artificial inhibition of the nervous system, characterized by total loss sensitivity, turn off reflex functions, relaxation of skeletal muscles and loss of consciousness. Anesthesia is administered by administering special types drugs that inhibit the transmission of interneuronal impulses. This manipulation is common in any field of activity starting from vascular surgery, ending with gynecology and has clear indications and contraindications.

General anesthesia

Classification:

Inhalation - the administration of anesthetics occurs through Airways. This type includes mask, endobronchial and endotracheal anesthesia.
Parenteral - anesthetics are administered intravenously, intramuscularly or rectally.
Combined - anesthesia is achieved using several anesthetics administered different ways and in a strictly defined order.

Features and Benefits

Portability different options anesthesia is individual, therefore, based on the specific characteristics and depending on the condition, the type of general anesthesia is selected separately for each patient. Also, the type of anesthesia depends on the type and size of the surgical procedure. For example, in gynecology, for short-term manipulation lasting 15-20 minutes, it is preferable to use intravenous anesthesia. Its advantage is that the introduction of anesthesia occurs quickly, without discomfort and consequences on the part of the patient. Awakening after such anesthesia occurs within a few minutes and is easier to tolerate. Unlike the mask type, there is no excitation phase, which simplifies the work with the patient. The effect of such anesthesia is short-lived (about 15 minutes), so if there is an unscheduled increase in the operation time, it is necessary to increase the dose of anesthetics.

Intravenous anesthesia

Please note: the most common types surgical operations in gynecology are curettage of the uterine cavity and abortion. They take from 20 to 40 minutes. For long-term operations, combined anesthesia is used, which consists of mask and intravenous anesthesia.

For long-term surgical procedures, it is better to use combined anesthesia, which may include parenteral anesthesia and inhalation. So, intramuscular and mask anesthesia can be used simultaneously.

Disadvantages and contraindications

Used for intravascular anesthesia narcotic drugs, for example, derivatives of barbituric acid; their long-term use is unacceptable, as it causes severe respiratory depression. They are administered in small doses (100 ml of 1% solution) and normally act for a short time (15-20 minutes). In view of this, it is necessary to have a device available artificial ventilation for use in case of apnea. The use of barbiturates is contraindicated if there is a risk of shock, collapse, severe respiratory failure and anemia. Other drugs such as: sodium hydroxybutyrate (10-15 g/kg), sombrevin (10mg/kg), ketaral (2-5 mg/kg) and Viadryl (15 mg/kg) are dangerous due to the development of such consequences as phlebitis and thrombophlebitis, hypotension and hallucinosis. The main contraindication is allergic reaction on drug components. However, in gynecology it is better to give preference to intravascular anesthesia over local anesthesia.

Important: before surgical intervention, if it is not an emergency, it is necessary to undergo an examination of organ systems. From functional state The type of anesthesia will depend on your body.

General contraindications for anesthesia are acute untreated conditions and depletion of body systems. These conditions include acute infectious diseases, severe rickets, acute neurological conditions, exacerbations of chronic pulmonary diseases and others. Even a short-term effect of drugs can critically aggravate the patient’s condition and lead to severe consequences. In gynecology, intravenous anesthesia is more often used than mask anesthesia. Intra-arterial administration of anesthetics leads to quick results, but in a certain situation there are contraindications more weight and it is better to protect yourself and the patient from serious consequences.