Anesthesia in gynecology – intravenous and other types of anesthesia in gynecology

Effect of intravenous anesthesia

The main advantage of this type of general anesthesia, compared to other types, is its immediate effect, which is practically not accompanied by a stage of excitement, and the same rapid recovery of the patient from the effects of the drugs administered to him.
Depending on the drug administered, one dose of the drug, on average, renders a person unconscious for 20 minutes. Based on this, if the operation is carried out over a long period of time, the anesthesiologist gradually adds the required amount of medication to prolong the patient’s unconscious state.

Intravenous anesthesia, from a technical point of view, is a very simple procedure that provides a very fast and reliable result. But in this case, complete relaxation of the muscular system cannot be achieved and the risk of drug overdose is quite high. Based on this, during long-term operations, a combined anesthesia of several types is mainly used.

Intravenous anesthesia in gynecology: technique, drugs, side effects

Relatively short-term intravenous anesthesia is often used in gynecology, because in this area of medicine there are many simple short-term operations and procedures (diagnosis of the uterine cavity, curettage, termination of pregnancy). And there is no point in giving the patient deep mask anesthesia if the intervention lasts only 20-30 minutes.

Principle

General intravenous anesthesia also allows you to turn off a person’s consciousness, so many patients needlessly fear that they will feel and be aware of something. Drugs injected into a vein begin to act instantly, and within a minute the person is asleep. And after the effect of the medicinal cocktail ends, he wakes up.

In gynecology, intravenous anesthesia is simply irreplaceable, because it allows you to perform some simple operations literally on the fly. A woman comes to the operating room, she is put under anesthesia through an injection into a vein and the intervention is performed. Then the patient is woken up and sent to the ward to finally come to her senses.

But unlike inhalation anesthesia, intravenous anesthesia does not cause severe side effects, so after a couple of hours the patient can already go home. She is kept in the hospital overnight only in extreme cases, if the operation was accompanied by complications. Intravenous anesthesia itself rarely causes any sharply negative reactions.

By the way! When performing gynecological operations under intravenous anesthesia, the doctor still performs local anesthesia of the operating area so that the patient does not wake up from pain ahead of time.

How is it carried out?

Despite the simplicity of intravenous anesthesia, everything is done by a specialist - an anesthesiologist. He preliminarily conducts a conversation with the patient, studies her medical record, and pays attention to blood pressure and pulse indicators. Then he asks the gynecologist about the approximate duration of the operation in order to calculate the dosage of the narcotic mixture.

The patient prepares for an operation with intravenous anesthesia in the same way as for any other: she takes all the tests, eats nothing in the morning, and removes all jewelry.
On the operating table, the woman is connected to machines that record blood pressure and pulse.
The nurse places a catheter in the vein, and the anesthesiologist gradually injects drugs into it and observes the patient's reaction.
When the woman falls asleep, the operation begins. If the intervention is delayed, the doctor may add some drugs into the vein. And sometimes anesthesia is even carried out using the bolus method: the continuous flow of a narcotic mixture into a vein through a drip system.
At the end of the operation, the patient is awakened in the usual way.

How does the woman feel? Nothing. She is simply sleeping soundly, but does not feel any touches from doctors or pain. Many people even dream about something. And the sleep is so pleasant and euphoric that you often don’t want to wake up.

By the way! Patients undergoing intravenous anesthesia breathe on their own. Although the anatomical features of some patients require the additional installation of a laryngeal mask, which does not allow the tongue to sink in and interfere with the free flow of air.

If this is a complex gynecological operation (late-term abortion, removal of tumors or organs), then intravenous anesthesia alone is not enough. Full mask anesthesia is performed. But first, drugs are still injected into the vein, which euthanize the woman and allow her not to experience discomfort from the installation of an endotracheal tube.

Drugs

For anesthesia in gynecology, the same drugs are used as in other medical fields. They are combined in different combinations and dosages to obtain the cocktail required for a specific operation.

Morphine + trimeperidine . The optimal mixture for most simple operations in gynecology.
Fentanyl + droperidol . The patient falls asleep almost instantly. Partial muscle relaxation also occurs.
Promedol + atropine + phenazepam . Eliminates the fear that the patient may have after waking up (if it is a morally difficult gynecological operation, for example, an abortion).
Other drugs can also be used in different combinations: propanidide, Viadryl, ketamine, sodium hydroxybutyrate , etc.

If the doctor makes a mistake with the dosage and gives too little intravenous anesthesia, this is noticeable in the patient’s performance and in her reactions. In this case, additional drugs are administered.

If there are initially too many of them, respiratory arrest may occur, which is immediately stopped by connecting to a ventilator.

Technically, this is a little more complicated, but there is no danger for the patient.

Contraindications

Emergency operations on which a person’s life depends are carried out despite contraindications. But planned gynecological interventions can be tolerated if a woman has:

infectious and inflammatory diseases;
cardiovascular failure;
acute respiratory tract diseases.

Pregnancy is a relative contraindication. And if only the operation can save the life of the unborn child, it is performed. The type of anesthesia (intravenous, mask or epidural anesthesia) is selected depending on the complexity of the surgical intervention.

Side effects

It cannot be said that in gynecology, after intravenous anesthesia, patients feel great. Euphoria can be seen only in the first minutes after waking up, and then you may begin to feel sick and dizzy. Many people note that this is reminiscent of a hangover, when you feel sick, your head is heavy, you want to sleep, but you can’t.

Pain in the operated area is not a side effect of intravenous anesthesia, but it is also present. And it is because of them that a woman cannot sleep. Of course, she is given painkillers, but its effect wears off sooner or later.

In rare cases, patients recover from intravenous anesthesia very hard and for too long. Usually they have enough strength on the same day to get home on their own. And there is bed rest, rest and recuperation.

Source: https://snarkozom.ru/ginekologiya/vnutrivennyj-narkoz/.html

Scope of application

The essence of this type of anesthesia is clear from the name - drugs (sleeping pills and painkillers) are administered through a vein.

Most often, intravenous anesthesia is used in gynecology, because it is in this area of medicine that rapid operations are often performed.

For example, surgical termination of pregnancy requires from 10 to 30 minutes - this is exactly how long the narcotic sleep lasts, into which the woman is immersed by injecting special drugs into the blood.

In general surgery, intravenous anesthesia is used in the following cases:

reduction of dislocations (local anesthesia will not help here, because the anesthesia zone is too wide);
electropulse therapy (method of restoring heart rhythm disturbances);
applying a splint to the injured limb (this is a painful manipulation, for which it is better to “disable” the patient);
convulsive syndrome due to epilepsy or tetanus and overdose of hard drugs (short-term anesthesia allows you to relieve severe psychomotor agitation for examination of the patient);
painful or unpleasant diagnostic procedures (FGDS, colonoscopy);
less often - in dentistry (if the patient is too excited and cannot overcome his fear).

The duration of intravenous anesthesia can be approximately calculated, as well as the duration of the future operation. If the intervention is delayed, the doctor adds a certain amount of anesthetic solution to the patient’s blood so that he does not wake up before all surgical procedures are completed.

If the operation initially involves a long intervention (more than 30-40 minutes), combined anesthesia is used. Then, before tracheal intubation, intravenous anesthesia is still first performed to achieve relaxation of all the patient’s muscles. Only after he “falls asleep” can a tube be inserted into the trachea.

Execution technique

A preliminary examination before the operation is carried out in order to prepare the patient’s body both for the intervention itself and for anesthesia.

The doctor studies the medical record in advance, asks about your health, medications taken, and allergies.

A few days before surgery, it may be necessary to premedicate – prescribe medications to reduce the patient’s anxiety level and minimize the consequences.

Intravenous anesthesia is performed by an anesthesiologist. The patient first arrives in the operating room and is placed on the table.
The person is fixed on the operating table to exclude reactions of muscle and skeletal hypertonicity to anesthetic drugs.
When everything is ready for the operation, the anesthesiologist performs premedication by injecting sedatives into a vein so that the descent into narcotic sleep is gradual.
Then anesthetic solutions are introduced, which “switches off” the patient: he falls soundly asleep.
The pressure may rise slightly - by 10-20 points. This is a normal reaction of the body.
The patient is unconscious, but he is breathing on his own. If the anesthesiologist notices that breathing is shallow, he uses an airway - a laryngeal mask, which is fixed in the oral cavity so as to prevent the tongue from retracting.

For short-term operations, bolus administration of drugs is used - i.e. a single injection into a vein. But more often a syringe pump is used for continuous infusion (drip of a solution into the blood), which eliminates the sudden awakening of the patient. In the second case, a catheter is fixed to the vein.

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The patient awakens after intravenous anesthesia when the effect of the drugs wears off.

The anesthesiologist can determine the approach of this by muscle reactions and help the person wake up by touching him or talking to him.

The doctor does not leave the patient until he is sure that he is fully conscious and has no critical complaints.

Drugs used

There are several drugs for intravenous anesthesia. Each of them has one degree or another of “putting a person to sleep.” The anesthesiologist must understand all these nuances in order to prepare solutions for specific patients for different types of operations. Anesthetic drugs can be considered based on the classification of intravenous anesthesia.

This method is based on the principle of multicomponentity. The composition of the finished anesthetic is “rich” in various drugs that combine well with each other. They allow you to achieve analgesia - a decrease in pain sensitivity. It is important not to overdo it with the dosage, otherwise the patient may have difficulty breathing to the point where he will have to switch to artificial ventilation.

Central analgesia involves the use of morphine and trimeperidine. These are narcotic analgesics that:

are quickly absorbed, reducing the perception of pain impulses by the nervous system;
inhibit conditioned reflexes;
give a hypnotic effect;
have a moderate antispasmodic effect on muscles and skeleton.

A method of intravenous anesthesia based on a combination of antipsychotics that suppress autonomic reactions and analgesics necessary for pain relief.

Most often it is a combination of droperidol and fentanyl, which helps to calm the patient almost instantly. After the administration of such a solution, narcotic sleep occurs very quickly.

At the same time, all reactions to surgery (spasms, reflexes) are reduced. Neuroleptanalgesia is often combined with local anesthesia.

For ataralgesia

This method of intravenous anesthesia is used when it is necessary to introduce the patient into a state of ataraxia - absolute peace of mind with the absence of any fears. Analgesics (promedol, fentanyl, ketamine), sedatives (atropine) and tranquilizers (diazepam, phenazepam) are used.

For anesthesia in gynecology, the same drugs are used as in other medical fields. They are combined in different combinations and dosages to obtain the cocktail required for a specific operation.

Morphine trimeperidine. The optimal mixture for most simple operations in gynecology.
Fentanyl droperidol. The patient falls asleep almost instantly. Partial muscle relaxation also occurs.
Promedol atropine phenazepam. Eliminates the fear that the patient may have after waking up (if it is a morally difficult gynecological operation, for example, an abortion).
Other drugs can also be used in different combinations: propanidide, Viadryl, ketamine, sodium hydroxybutyrate, etc.

If there are initially too many of them, respiratory arrest may occur, which is immediately stopped by connecting to a ventilator.

Technically, this is a little more complicated, but there is no danger for the patient.

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Local anesthesia

When using this type of anesthesia, pain is not completely eliminated. This is explained by the fact that during the process of curettage of the uterine cavity using a curette, there is severe pain in the uterus itself. That is, local anesthesia can greatly dull pain, but it does not have the function of completely blocking them.

The mechanism of action of such anesthesia is that a local anesthetic is injected into the tissues located near the cervix. Often, with the help of this type of anesthesia, conization is performed, after which the patient does not need a long stay in the hospital.

However, today this method of anesthesia is rarely used during curettage, since there is a risk of the drug entering the blood vessels located around the cervix. This is fraught with loss of consciousness, seizures and disruption of the functionality of the cardiovascular system.

Disadvantages and contraindications

For intravascular anesthesia, narcotic drugs are used, 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 ventilator available 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.

General contraindications for anesthesia are acute untreated conditions and depletion of body systems. Such 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 serious consequences.

Almost any patient's condition that requires immediate (emergency) or planned surgical intervention is an indication for the use of intravenous anesthesia. Preference is given to operations that do not take much time. Otherwise, the type of anesthesia is selected individually, taking into account the patient’s condition.

If emergency surgery is necessary, there are no absolute contraindications for intravenous anesthesia. Israeli anesthesiologists will select the type of medications that will have the most gentle effect on each individual organism.

In the case of a planned operation, there are several contraindications to this type of anesthesia:

Disruption of the cardiovascular system - severe heart rhythm disturbances, myocardial infarction, if little time has passed since the onset of its development (less than a month), stable or unstable angina, characterized by a severe form of the course, heart failure (uncompensated).
Acute diseases of the nervous system.
Acute infectious diseases of the respiratory tract, in particular bronchial asthma during exacerbation, pneumonia, acute bronchitis or chronic bronchitis in the acute stage.
Infectious diseases.

In addition to contraindications of this nature, there are also contraindications to the use of one or another drug used during anesthesia. Each drug has its own. Individual intolerance of an individual organism to barbiturates administered as an anesthetic should not be excluded.

Intravenous anesthesia | University Clinic

Infusion of anesthesia drugs into a vein allows you to quickly put the patient into a state of anesthesia, does not require expensive equipment, and has a minimum of side effects. This anesthesia is recommended for procedures lasting less than 30 minutes and as an auxiliary anesthesia for other types of anesthesia.

What drugs are used for intravenous anesthesia?

For intravenous anesthesia, modern drugs or their combinations are used: sodium thiopental, metahexitone, ketamine, sombrevin, etomidate, etc.

Most anesthetics are administered by continuous infusion (drip) or a single intravenous injection. The method of administration depends on the nature and duration of the surgical intervention.

Features of intravenous anesthesia: selection parameters

Each type of anesthesia has its own characteristics, which may be advantages in some conditions and disadvantages in others.

If we are talking about intravenous anesthesia, it, unlike mask and endotracheal (gas supply through a tube directly into the lungs) anesthesia, can be given to patients suffering from respiratory diseases.

Drugs administered intravenously do not cause post-anesthesia tracheal irritation.

In addition, during a number of operations it is not allowed to have air-filled spaces inside the patient’s body—intravenous anesthesia is again suitable here.

At the same time, this type of anesthesia is not suitable for complex operations, since it does not provide long-term sleep, and an overdose causes serious health problems. Therefore, it is recommended for pain relief during simple surgical interventions and painful diagnostic procedures.

With proper dose calculation, it is guaranteed:

easy and quick onset of anesthesia;
absence of a period of excitement - a condition that some patients are so afraid of, in which uncontrolled speech is possible;
easy recovery from anesthesia.

By limiting the effect of the drugs over time, there is minimal inhibition of heart function, which is associated with a minimal set of contraindications.

Preparing for intravenous anesthesia

Before anesthesia is administered, the patient is consulted and examined by an anesthesiologist. The doctor selects the optimal dose of painkillers and determines the method of anesthesia.

On the day when anesthesia will be given, you should not eat in the morning. Cleansing enemas are prescribed. To prevent complications associated with holding your breath, removable dentures are removed from the oral cavity.

Before intravenous anesthesia, additional drug preparation is carried out, called premedication. Thanks to the use of special medications:

fear and nervousness that can affect your well-being before surgery go away;
the effect of anesthetics improves, and ease of induction into sleep is ensured;
The secretion of excess saliva is eliminated.

The preparation regimen may include several types of drugs, for example, the doctor may prescribe:

the evening before surgery: sleeping pills intramuscularly or in tablets;
2-3 hours before surgery - diazepam and droperidol;
30-40 minutes before anesthesia - promedol, atropine sulfate, diphenhydramine.

In case of emergency interventions, premedication is carried out immediately on the operating table. M-anticholinergics, analgesics and antihistamines are administered intravenously. Their dosage depends on the person’s weight.

Carrying out intravenous anesthesia

With total intravenous anesthesia, drugs are administered dropwise into a vein. Most often, two types of drugs are used for pain relief: analgesics and hypnotics.

First, a small loading dose is administered, and after the patient falls asleep, a maintenance infusion of drugs is administered. As a rule, the rate of administration of one of the components remains unchanged, while the other varies. This makes it possible to use intravenous anesthesia much more widely and effectively.

For pain relief during short operations and painful procedures, drugs are injected into a vein once. This technique is called monoanesthesia.

After administering the drug, the doctor constantly monitors everything that happens to the patient. Modern equipment monitors the parameters of the body’s condition: heartbeat, pressure, temperature, saturation (oxygen saturation) of the brain, etc. Special sensors will report any changes, and the anesthesiologist will immediately take action.

Disadvantages and complications of intravenous anesthesia

The intravenous method of anesthesia has certain limitations:

cannot be used as independent pain relief during long-term and extensive surgical interventions. In these cases, it is combined with mask or endotracheal anesthesia;
intravenous anesthesia should only be performed by an experienced specialist: an overdose of the drug leads to inhibition of the nervous and respiratory systems.

Complications with intravenous anesthesia are quite rare. Most often, drug intolerance and prolongation of post-anesthesia sleep caused by incorrect dosage are observed.

Some patients may experience pressure changes, headache, weakness, and dizziness. These phenomena go away on their own after some time, without requiring treatment.

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Source: https://unclinic.ru/vnutrivennaja-anestezija/

Sedation

Sedation is currently a fairly common type of anesthesia during curettage. When using it, the patient is given an injection of a narcotic analgesic that functions as an anesthetic (promedol) or a tranquilizer (diazepam) is injected into a vein.

Sedation is performed mainly in a day hospital and in most cases is done in order to terminate the pregnancy process, or when a tissue biopsy is necessary. With this type of anesthesia, the presence of a specialist anesthesiologist is not necessary. Just like local anesthesia during uterine curettage, it can be performed by a gynecologist.

As a rule, this procedure uses minimal dosages of drugs, so there is little clinical effect. If the drugs are used in large doses, the effect will be stronger, but the functioning of the body’s respiratory system may be disrupted, which only an anesthesiologist can normalize.

Throughout the entire process, the patient experiences a half-asleep state, and the pain does not completely disappear. The woman also hears surrounding voices and can observe the events taking place. This is also due to the fact that the administered drug has a small dosage.

Anesthesia for gynecological operations: general, intravenous, epidural, etc.

The idea has become firmly established in the public consciousness that any gynecological manipulations and operations are necessarily accompanied by severe pain for the patient. An example traditionally cited is the procedure of abortion, during which the woman is fully conscious and experiences unbearable pain.

This is what often explains the categorical reluctance of many ladies to regularly visit a female doctor, and all the exhortations of doctors and the inadmissibility of a disregard for their own health run into a wall of misunderstanding. That is why the question regarding existing types of pain relief for certain gynecological procedures is so important.

We will try to figure this out.

Inhalation anesthesia

Modern medicine has long abandoned the use of chloroform, using much safer compounds: ether, cyclopropane or nitrous oxide. There are several main types of inhalational anesthesia.

Scope of application: minor and minimally invasive gynecological operations and procedures: removal of condylomas, polyps, traumatic types of diagnostics.

Ether anesthesia by intoxication. The permissible total duration is relatively short, which is compensated by a significant reduction in pain and reliability of the final result.
Deep ether anesthesia. In this case, a special Ombredan-Sadovsky mask is usually used, connected to a device for supplying a mixture of oxygen and ether. Recently, this type of anesthesia is giving way to endotracheal anesthesia, which completely eliminates the possibility of diaphragmatic contractions. The main disadvantages of the method are associated with a small probability of respiratory paralysis, cardiac arrest and a long period of postoperative rehabilitation. Also, we must not forget about the side effects, expressed in subsequent vomiting, prostration, headache and problems with the respiratory system (pneumonia and bronchitis).
Deep ether anesthesia using the Ombredan-Sadovsky mask
Nitrous oxide anesthesia. At first glance, Laughing Gas has many advantages. It rarely causes irritation of the mucous membranes, promotes quick and sound sleep, has virtually no contraindications and is free from postoperative side effects. But this comes at the cost of high complexity of equipment and the risk of asphyxia. The disadvantages of nitrous oxide also include the insufficiently deep effect during long, multi-hour operations and the need for increased control by the anesthesiologist.
Anesthesia using cyclopropane. If we do not remember the increased flammability of this gas, this type of anesthesia could be called ideal. Sufficient depth of action for any operation, no negative impact on the cardiovascular and respiratory systems, rapid onset of effect and easy awakening.

It is based on the work of Pierre Huguenard and Henri Laborie, who in the 1950s proposed the idea of so-called pharmacological artificial hibernation, a condition similar to hibernation in some animals.

The combination of several substances used in this case has advantages over mono-anesthesia.

In this case, one drug either enhances the effect of others, or in combination each of them gives a greater effect than individually.

Scope of application: extensive and long-term abdominal operations, when it is necessary to achieve a stable and permanent effect.

Possible components of such anesthesia:

Neuroplegic substances. The most famous representative is aminazine, although the popular antihistamines have somewhat similar properties: ethizine, reserpine, diprazine and diphenhydramine. Its other components are diprazine (antihistamine), promedol (analgesic) and glucose, sometimes replaced by novocaine.
Relaxers. By themselves, they do not have an analgesic effect, but they help relax the muscles of the peritoneum, block the neuromuscular synaptic mechanism and allow simple operations to be performed under shallow anesthesia.

Non-inhalation anesthesia

Scope of application: any large-scale surgical interventions: hysterectomy, adnexectomy, cystectomy, conservative myomectomy.

Hexenal anesthesia.
It is used as a solution of 1 g of active substance and 10 ml of water, injected into a vein immediately before surgery. Due to the high risk of respiratory arrest, intravenous injection can be replaced with intramuscular or even rectal.
The duration of sleep after surgery is about 2–3 hours.
Thiopental sodium anesthesia.
The solution is administered using a double drip apparatus, and the patient’s condition is constantly monitored. Due to the use of narcotic drugs, this type of anesthesia requires highly qualified medical personnel and is not without the risk of side effects.

Intravenous (general) anesthesia

General (intravenous) anesthesia for curettage is performed only by an anesthesiologist in the operating room. Before this procedure, the anesthesiologist must find out from the woman whether she has previously had head injuries, what surgical interventions using general anesthesia she has previously undergone, what her body weight, height, and so on. A specialist needs this information in order to choose the right medications and calculate their dosage.

When using general anesthesia, the patient does not experience any sensations. Cleaning usually lasts within one hour, the minimum time is twenty minutes. After the operation is completed, the woman wakes up almost immediately and quickly regains consciousness. Such short-term pain relief rarely causes any complications in the future, and there are no negative consequences for the body.

Such planned operations are usually scheduled for the morning. An important point is that the patient should not take food or liquid in the evening.

General anesthesia today is considered the most common type of anesthesia for curettage. This is due to the following reasons:

short duration of the procedure;
the use of this method of pain relief during operations aimed at treating diseases such as hyperplasia (provokes the development of cancer, which can be stopped with curettage) and the endometrium (in some cases, for more effective treatment of such a disease, cleansing is prescribed along with antibiotics);
impossibility of getting leftover food from the stomach into the lungs;
maintaining the woman’s spontaneous breathing (the patient breathes independently with the help of an oxygen mask);
presence of sound sleep;
no pain.

What kind of anesthesia in gynecology is used for removal of the uterus and abortion with curettage

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

General principles of pain relief

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

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

blackout;
elimination of the body’s reflex reactions 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 of the posterior fornix, curettage of the uterine cavity or abortion, sedation or local anesthesia is sufficient, and for extensive ones, general and sometimes epidural anesthesia is used.

Local anesthesia

Anesthesia involves pre-treatment of the tissues around the cervix with a local anesthetic - lidocaine or novocaine, to block pain during uterine manipulation.

To prevent the anesthetic from entering the blood vessels, gynecologists perform interventions under anesthesia, reminiscent of 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 is a type of general anesthesia that 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:

During vacuum cleaning, obstetricians prefer to use local anesthesia, but the patient experiences discomfort and sometimes mild pain. 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 is deep sleep induced by 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. During these surgical interventions, depending on the initial condition of the patient, age, and the urgency of the operation, 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 endotracheal anesthesia. Its disadvantages are the likelihood of respiratory arrest, as well as the long process of 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 of the spinal cord begins - Cauda equina - the so-called. ponytail.

Spinal is used for conditions with low blood pressure. The active component is a solution of novocaine 4-5%. It is injected into the subarachnoid space using a syringe.

The risk of any manipulation in the area of the spinal canal - a decrease in blood pressure (sometimes significant) or the occurrence of palsy - is extremely rare in the good hands of a doctor! 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 region, 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.

Source: https://vnarkoze.ru/akusherstvo-i-ginekologiya.html