The frequency of cesarean sections is increasing from year to year, and the choice of optimal anesthetic management is important. Regional anaesthesia is the anaesthesia of choice for the cesarean section because it reduces maternal and neonatal risks. If an epidural pain relief of labor is performed, then this epidural catheter can be successfully used for conversion to epidural anaesthesia. The choice of drug for conversion depends on the degree of urgency; the highest rate of onset of anesthesia is shown by lidocaine with adjuvants (fentanyl, sodium bicarbonate). Conversion failure occurs in 0–21% of cases; the main risk factors for conversion failure are inadequate epidural analgesia and patient height. The management of failed conversion depends on the category of urgency and other factors and may include spinal, combined spinal-epidural, or general anesthesia
This article outlines the main guidelines of the European Society of Anesthesiologists for Perioperative Venous Thromboembolism Prevention and the basic guidelines of the Society for Obstetric Anesthesia and Perinatology (SOAP) for Enhanced Recovery After Cesarean (ERAC). The search for effective methods of recovery after caesarean section, the desire to reduce the risks of postoperative complications, to shorten the length of the hospital stay led us to the introduction of the modern concept of rapid recovery. The concept of Enhanced Recovery After Cesarean is already used in the “Leleka” maternity hospital. The positive results of the implementation of the ERAC concept in obstetric practice make it necessary to modernize the traditional approach to the postoperative period.
Labour pain is recognized by some women as the most severe pain that they have ever felt in their life. Epidural analgesia is an effective method of pain relief in labour and is considered as the gold standard of analgesia for delivery. Traditionally, epidural analgesia in Ukraine is performed without the ability for the patient to control the process of anesthesia. The authors became interested in the delivery of local anesthetics by patientcontrolled epidural analgesia instead of the traditional physician methods. In randomized controlled studies there is an evidence that the PCEA method tends to improve the quality of pain relief and increase the patient satisfaction.
Safe and adequate sedation during regional anesthesia is one of the issues at the current time. According to the basic principles of modern anesthesiology, safe and effective sedation should protect the patient’s psycho-emotional sphere, provide absence of awareness, pain and fear during surgery as well as nausea and vomiting in the postoperative period. At the same time, it should neither cause respiratory depression and haemodynamics changes, nor be accompanied by a slow recovery of psychomotor function.After studying modern literature and analyzing our own observations, we reached the point that sedation with dexmedetomidine rather than propofol is more preferred during regional anaesthesia. Sedation with dexmedetomidine decreases frequency of cognitive impairment in the early postoperative period, intensity of the pain syndrome, and has beneficial effect on recovery and activation after surgery. Additionally, it is associated with lower risk of hypoxemia and arterial hypotension during surgery.
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