Should anesthesia be used during external version surgery? What kind of anesthesia should be used?

External version is an obstetric breech presentation surgery. Breech presentation accounts for about 3% to 4% of all births. Breech presentations are associated with a high incidence of premature birth, premature rupture of membranes, and umbilical cord prolapse, which can easily lead to asphyxia and birth injuries. The perinatal mortality rate of vaginal births is about 10 times that of cephalic births. The harm of breech presentation to the mother is that there are many complications caused by surgical delivery, such as birth injuries, bleeding, and infection.

Especially the harm to the fetus has led many women to choose cesarean section directly.

It can be said that external valgus version is an ancient technique. As long as there is a master who can turn the fetus right and deliver the baby normally through vagina, the result will be a happy one for everyone. For this reason, the medical community is also thinking about how to combine external valgus version with modern medicine.

In recent years, many hospitals have also made attempts in this regard. Among them, there are mainly two factions: those who insist on no anesthesia and those who insist on anesthesia. Both sides have their own opinions. Those who insist on no anesthesia are mainly worried about the risks of anesthesia. Those who insist on anesthesia raise the issue of maternal comfort, abdominal muscle relaxation, and the possibility of switching to cesarean section at any time.

So, from the perspective of anesthesiology, should anesthesia be used during external version surgery?

It can be said that every anesthesiologist has a kind heart. Excluding other factors, anesthesiologists are willing to perform anesthesia on all patients. There are very few patients who cannot be anesthetized! Anesthesia is not to push the patient into the abyss, but to save the patient's fragile life. If the patient cannot even tolerate anesthesia, the operation is almost meaningless.

However, the reality of blame-shifting, division of responsibilities, and lack of sense of achievement has made the anesthesiology department very cautious. Even many doctors have the idea that "less is worse than more", which is a terrible thing!

This is understandable: we are not saints, and everyone wants to be recognized for what they do. Even if they are not recognized, it is acceptable to work in vain. However, doing good things but having to take responsibility for the consequences is something that most people cannot do.

It can be said that the main consideration for those who say that anesthesia should not be used is not the safety of anesthesia technology, but other issues.

If other problems are solved and anesthesiologists can focus on performing anesthesia, more patients will benefit.

So, if anesthesia is used, what kind of anesthesia should be used?

There is no doubt that spinal anesthesia should be the first choice. As for combined spinal epidural anesthesia and epidural anesthesia, it depends on personal opinion. In comparison, theoretical things need to be based on the technical level and experience of the implementer.

As the saying goes, there is no best anesthesia plan, only anesthesia plan that suits you better.

As long as it can ensure patient safety, no complications, quick patient recovery and good experience, this is a good anesthesia plan.

In addition, spinal anesthesia itself can relax the abdominal muscles, which is conducive to the implementation of external version. Once the cesarean section is transferred, it can also meet the needs of the cesarean section. There is no reason not to choose this anesthesia option.

There is another point we need to pay attention to: Is general anesthesia an option?

If the external version fails, a cesarean section can be performed directly under general anesthesia, and the baby will come out quickly. The anesthesiologist is always present, and there is no problem in ensuring the safety of mother and baby. However, what if the external version is successful? Even with the best anesthesia plan, no one dares to say that the drugs will not have any impact on the mother and baby.

In addition, even if the use of drugs is reasonable in theory and the time of postoperative problems is theoretically completely unrelated to anesthesia, people's words are scary. Childbirth has a huge impact, and anyone who participates in it may be implicated. In particular, the public is not very familiar with the safety of general anesthesia. It is very likely that if something goes wrong, people will think of general anesthesia.

If you undertake this anesthesia task, please pay attention to the following:

1. If the patient is a multiparous woman, external version may be more successful and less time-consuming due to the relaxation of the abdominal wall muscles;

2. Uterine contraction inhibitors are used during external version, which may affect maternal blood pressure, heart rate and other circulatory indicators, and may even affect the patient's respiratory system. Adequate response plans must be prepared;

3. Although studies have shown that fetal size has little impact on outcomes, it may actually have an impact;

4. Be sure to consider the level of the obstetrician. If you are a novice, be cautious.

Regarding how to anesthetize external version surgery, please leave a message below and express your insights~

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