When giving general anesthesia to pregnant women, what are the anesthesiologists worried about?

At present, general anesthesia technology is very mature. It can be said that most operations can be completed under general anesthesia. However, there is one exception - cesarean section anesthesia.

Whether in academic exchanges or daily chats, anesthesiologists seem to be very worried. So, what are anesthesiologists worried about?

First of all, I would like to state that what we are most worried about is not technology, but people.

Who?

Patients or their families, or some people who think the matter is not a big deal.

So, if the "people" we are worried about are no longer the main problem, how should we implement general anesthesia for cesarean section? What details should we pay attention to? Let's take a look:

There are reports that pregnant women may have a difficult airway due to obesity, enlarged tongue, edema of the throat and tracheal mucosa, and fragile and easily bleeding oral mucosa. In other words, some anesthesiologists are worried about the problem of airway establishment in pregnant women. But for the vast majority of anesthesiologists who often perform general anesthesia, this should not be a big problem.

If the impact on pregnant women is not the main factor, let’s look at the impact on newborns:

It is generally believed that compared with spinal anesthesia, general anesthesia will cause a decrease in Apgar scores, which should be the biggest concern of most anesthesiologists. After all, the safety of mother and child is the credit of obstetrics, and if there is a problem, it is the responsibility of the anesthesiology department.

However, some studies have shown that although general anesthesia can cause respiratory depression in neonates, the depression is short-lived, and the arterial oxygen partial pressure and arterial oxygen saturation values ​​are higher. Compared with the spinal anesthesia group, there were no statistically significant differences in maternal hemodynamics, neonatal Apgar scores, and blood gas analysis in the general anesthesia group.

This is also easy to understand: at present, both anesthetic drugs and anesthesia techniques have been rapidly developed. In particular, anesthesiologists are becoming more and more proficient in the application of drugs and can achieve precise control.

For example, in the selection of intravenous anesthetic drugs, medium-chain propofol can be preferred. Medium-chain propofol fat emulsion is made by adding medium-chain triglycerides to long-chain propofol. It has higher solubility, can reduce injection pain, is metabolized faster, and has minimal impact on the fetus.

So, if general anesthesia is implemented, does it increase the difficulty of perioperative management for other departments or the anesthesiology department itself?

For the operating room, general anesthesia does not affect the turnover rate of the operating table. After all, most hospitals have postoperative recovery rooms. Besides, such a young patient generally does not have serious complications of delayed awakening. Therefore, the nurse sister has no objection.

For obstetrics, timely breastfeeding after surgery should be considered. However, the preferred anesthetic drugs during cesarean section general anesthesia have short half-lives and fast metabolism. During postoperative breastfeeding, the residual drugs in breast milk are not enough to cause an anesthetic effect.

For the anesthesiologists themselves, general anesthesia may require more preparation and the operation process may be more complicated, but this is not important. Again, the anesthesiologists may be most worried about things other than the medical process.

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