theCareer girlVeterinary continuing education onlinenews, Ph.D.Add rhett · pazzi oettingerVeterinary, VMD, DACVECC solves the cesarean section in patients with anesthesia problem!Anesthesia for patients with any is a terrible idea, not to mention the anesthesia in patients with pregnant!In short, we know that will happen to a variety of physical and hormonal changes during pregnancy, pregnant patients happen will happen to the fetus.

Pregnancy can lead to many important physiological change (Tranquilli WJ, et al. Veterinary Anesthesia and Analgesia, 4 th Ed., Blackwell, 2007:956) :

  • Add:
    • The heart rate
    • Cardiac output (30-50%)
    • HP (40%)
    • Plasma volume
    • Minute ventilation
    • Oxygen consumption (due to fetal metabolic demand)
    • Gastric emptying time/stomach pressure (increase the risk of reflux)
    • Renal blood flow and GFR
  • Reduce:
    • Packed cell volume (PCV)
    • hemoglobin
    • Plasma protein
    • PaCO2 (progesterone increased sensitivity to the CO2)
    • Functional residual capacity
    • gastrointestinal
    • Gastric acid alkalinity
    • Urea nitrogen, creatinine

Therefore, we need to know, understand and prepare to anesthesia in patients with pregnancy.

Before anesthesia and cesarean section, clinicians should make a thorough physical examination and the preoperative examination of the important.

    • Blood work- what is important is that we want to evaluate potential complications and electrolyte disorder, including calcium levels, ideally is calcium ions
    • An X-rayEvaluation of the fetus number as wellAbdominal ultrasoundAssessment of fetal heart rate, which is especially important for emergency cesarean section, rather than a planned cesarean section.

Once the clinical doctor and nurse team satisfied with the inspection and preoperative testing, the team will perform as much as possible before delivery of preoperative task, purpose is to reduce the time of anesthesia.

  • Abdominal clip and initial scrub (real sterile operation need surgery for a more thorough scrub).
  • When necessary for intravenous infusion treatment (such as dehydration, insufficient blood volume).
  • Beforehand oxygenation
  • Maropitant, before the anesthesia, intravenous 1 mg/kg also can consider to reduce the risk of vomiting/reverse flow
  • To set up the neonatal recovery station
    • bulb
    • ET tube or pipe
    • naloxone
      • Reverse opioids
    • adrenaline
      • If they bradycardia
      • Atropine can also be considered the adrenaline causes obvious tachycardia
    • O2
      • Pediatric/exotic masks - once the puppy recovery, can consider to place them in a plastic box containing oxygen (similar to the past used to hold the cat box)
    • Hot support
    • towel

Ideally, during the care team to prepare for the patient, the surgeon should prepare for surgery, including scrub, wear robes/wear gloves and prepare their instrument table, so that everything is ready before patients were induced.

About drugs, we must remember that patients receiving any treatment, the fetus may also be treated.Most of the sedation or anesthesia drugs can cross the placenta.The following is a recommended drug scheme of cesarean section.Note: this may be not safe for all patients, it is recommended that establishing a safe and effective for patients with your plan.

  • Cesarean section drug plan
    • Before taking the medicine(a short-acting opioid drugs)
      • Fentanyl 5 MCG/kg IV - fentanyl work fast, 1 to 2 minutes, remove fast (about 30 minutes).During this period, the patient should accept the supplemental oxygen during pre oxygen filling.
      • Bhutto brown, 0.4 mg/kg IV - according to the availability or patient needs, can consider to take the place of fentanyl.For example, brown is unlikely to cause vomiting, bhutto may be beneficial in patients with a short head.
    • inductionEffect - similar to preoperative medication, generally use the following one, rather than mutual combination)
      • Propofol 4 to 8 mg/kg IV - propofol does cross the placenta, but fortunately was quickly removed.
      • Afar methadone - compared with propofol, this could be the best choice for patients with heart disease
        • 2 mg/kg IV dogs
        • 5 mg/kg intravenous cat
      • Line block- after induction, can consider to place line block on the white line, in order to reduce intraoperative and postoperative medication needs.
        • Lidocaine 2 mg/kg
        • Cloth than paid 1 mg/kg (also can consider Nocita)
      • Maintenance of your kitchen utensils and appliances- inhalation anesthesia
        • As mentioned above, we are restrictions on the use of other drugs, these drugs may be part of your normal preoperative drug library (such as benzodiazepines drugs).As a result, patients may need to transport inhalant at a rate higher than expected.
        • Higher rate of suction side effects include low blood pressure (hypotension).
        • If it is found that low blood pressure, can consider rehydration.
        • If they are hypotension and bradycardia, can consider to long bromide.RON bromide don't cross the placenta
        • If low blood pressure and heart rate is normal, can consider to methamphetamine.Ephedrine is not easy to cross the placenta.
        • Dopamine CRI can consider surgery for longer.Dopamine can through the placental barrier, but the impact is very small.
        • If the distance is the last time for more than 30 minutes, and then again after fetal childbirth dose fentanyl.
        • Consider given buprenorphine, at the end of the surgery to take immediately after they wake up.
      • Also can consider to epidural anesthesia, especially for planned cesarean section, because they can significantly reduce the body needs.
        • Using 2% lidocaine (1 ml/kg) 10 + / - opioids
        • If the fetus is in trouble and/or the dam had delivery for a long time, it should not waste time trying to epidural anesthesia.

It can consider the above scheme, but some anesthetist will not for patients with preoperative medication.Another method is to allow patients to prepare clips and scrubbing (initial).And then lead the patients into the operating room in the operating room, in the process, the surgeon scrubbed and prepared beforehand oxygenation.Patients with methadone induced by propofol or o method, and then accept the inhalation anesthesia (isoflurane and sevoflurane).The agreement to limit the drug treatment of fetal (such as the dog), and don't have to worry about/that reverse any dog.If it is selective and they do not feel pain, they are more likely to be vigilant and move after childbirth.Once the puppy, patients would accept hydrogen morphine ketone (0.1 mg/kg).

  • Repair tools
    • Buprenorphine 0.02 mg/kg IV
    • A single dose NSAID
      • 4 mg/kg card ibuprofen dog
      • In the milk limited
    • oxytocin
      • 5-20 units titration effect
    • Hot support
    • O2 support if needed
    • Baby woke up and immediately sent him back the sow (if they remain calm, newborn accident trauma can increase the risk of)
    • Encourage nursing
  • On neonatal recovery, and matters needing attention/preparation including:
    • Clearing the airway
    • No wavering neonatal hedge injury (coup)
    • Dry to keep the heat and force to stimulate breathing
    • Associated with high morbidity/mortality of hypothermia
    • HR should be > 180 BPM, if < 180 BPM, worry is myocardial ischemia.After childbirth stimulation during another reason for the above mentioned supplemental oxygen.
    • When necessary, intubation
    • VETgirl Pearl: you can use the butterfly cut needle catheter, connect the wire to syringe to provide suction, and can be safely smoke inhalation.
  • It is important to note that should avoid the use of drugs, including:
    • Benzodiazepines, alpha 2 agonists settlement agent
    • Used to think mask is the best choice, because such as isoflurane inhalation will last a long time, and can minimize the exposure of the drug on the fetus.Cover will increase the pressure of the patients, however, requires a high level of isoflurane, and increase the risk of complications such as hypotension and aspiration pneumonia.

Garret, Dr Pachtinger DACVECC

The resources

  • Brock n. cesarean anesthesia.117 Can Vet J vol 37, 1996:118 - XNUMX.
  • Metcalfe S and others.Multicenter randomized clinical trial to evaluate the anesthesia induction of bitches before cesarean section, the method, efficacy and safety of methadone.Australian vet magazine2014;92:333-338.
  • Luna SPL, etc.Four puppies nerve anesthesia scheme for cesarean section and the influence of cardiopulmonary variable.Veterinary record (2004) 154:387-389
  • And the moon PF.The United States and Canada cesarean section puppies perioperative risk factors.J Am Anim Hosp Assoc. 2000;And 9-68.
  • Moon - Massat PF, Erb HN.Associated with cesarean section puppy dynamic perioperative factors.J Am Anim Hosp Assoc.38 months / 90, 2002, volume.96;XNUMX - XNUMX.
  • Ryan, SD, Wagner AE.Dog caesarean section: anesthesia management.Summary: 2006-57 44.
  • She's morning.Dogs and cats during childbirth of surgical treatment.Animal genetics, 70 (2008) 337-342.

  4. The home of August Said:

    Dr Read well, Mr Oettinger cutting!I after commission certification Theriogenologist started under the guidance of my career, his paradigm is very comply with these guidelines.More O2 in front of the road, he jumped over the PA, directly to the Sx - he is very conservative, drugs for most of his C seconds are has the performance quality of AI P, in Sx/recovery period, the breeder/owner always present.

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