Up to now, neuraxial anesthesia is still the main anesthesia for cesarean section. Among them, combined spinal-epidural anesthesia accounts for its fast onset, good muscle relaxation effect and low postoperative complications.
However, the effectiveness of combined spinal-epidural anesthesia is influenced by a number of factors. For example, factors such as the ratio of spinal anesthesia drugs, the speed of drug pushing, and the puncture position of mothers are affected.
In view of the drug ratio of spinal anesthesia and the speed of drug pushing, anesthesiologists who often perform combined spinal-epidural anesthesia have a lot of experience. However, some friends may not be too clear about the effect of the puncture position.
There is a clear difference between the puncture position for cesarean section and the anesthesia for general surgery. Because, there is a frequent complication of cesarean section anesthesia - supine hypotension syndrome.
To reduce the incidence of this syndrome, anesthesiologists often use the option of tilting the operating table to the left 30 degrees. However, some anesthesiologists have found that using a right-sided decubitus puncture with a right-sided decubitus tilt for 2 minutes and then adjusting the operating table to a 30-degree left tilt can reduce the incidence of the syndrome.
So, is there a difference in the anesthetic effect of doing so other than reducing supine hypotension syndrome?
Let's take a look at the detailed differences in a clinical study.
Anesthetic method: All puncture procedures are performed by the same skilled attending physician. The L3-4 intervertebral space was selected as the puncture site. After successful puncture, the opening of the spinal anesthesia needle is facing the cephalad side, and the spinal anesthetic drug is injected at a uniform rate within 30 seconds after the cerebrospinal fluid can flow out smoothly, and the anesthetic drug is the heavy weight.
The first group performed the right decubitus puncture; The second group performed left decubitus puncture. After the epidural space catheterization is fixed, the woman is placed in a supine position with a left tilt of 30 degrees. The difference between the two groups is that in the right decubitus puncture group, it is necessary to maintain the right tilt for 2 minutes after the repuncture is completed, then adjust the operating table to the left 30 degrees, and level the operating table before the operation begins.
The results showed:
1. The final block plane of women in the right decubitus position group was significantly lower than that of the left decubitus group, and the time required to reach the final block plane was significantly shorter than that in the left decubitus group.
2. The dosage of ephedrine in the right decubitus group was significantly lower than that in the left decubitus group.
3. The umbilical artery pH value in the right decubitus group was significantly higher than that in the left decubitus group.
4. There was no significant difference in neonatal Apgar score between the two groups.
Overall, the right decubitus puncture is advantageous.
So, why is the right decubitus puncture better?
The mother was placed in the right side decubitus position for 2 minutes and then turned to the left tilt of the operating table at 30 degrees, which could fully spread the heavy gravity of the spinal anesthetic drug to the left and right sides. The anesthetic level may be slightly lower due to the drug distribution on both sides. At the same time, it also avoids the occurrence of unilateral spinal anesthesia caused by heavy specific gravity.
Will it cause the anesthesia plane to be too low?
In fact, the plane of the right decubitus puncture is only slightly lower than that of the left decubitus. However, this is also effective in lowering the plane to reach thoraco4. If the plane reaches thoracic 4, the sympathetic nerve can be blocked, resulting in bradycardia and decreased cardiac output.
In the case of sympathetic block, not only will the mother vomit, but the risk of cardiovascular depression is of greater concern. So, is it better to choose a right-sided puncture? Welcome to leave a message to communicate~
Qin Haiyan, Department of Anesthesiology, Binzhou People's Hospital