The patient with pregnancy can become an object of attention of the anesthesiologist in any of pregnancy trimesters. In spite of the fact that pregnancy in itself pathologies is not, during it in an organism of the pregnant woman there are significant changes capable to influence anesthesiology tactics. Changes during pregnancy affect all organism of the patient, but especially they concern the cardiovascular system, a digestive tract, the system of a blood coagulation and also sensitivity to anesthetics. The features of physiology of the pregnant woman are characteristic of each trimester.
In the first trimester of pregnancy the most widespread intervention is abortion, or elimination of consequences of a misbirth. Also surgeries and manipulations concerning the accompanying pathology can be made. Considering high risk of abortion during this period, carrying out the general anesthesia only according to the emergency indications is expedient (except for abortions at the request of the woman). Besides, after 16 weeks of pregnancy begins to delay gastric emptying, the acidity of a gastric juice therefore after this term all pregnant women treat risk group on regurgitation, aspiration and development of a syndrome of Medelson increases. It has to be considered when choosing an anesthesiology grant: after 16 weeks give preference to regional techniques of anesthesia, carry out prevention of an aspiration syndrome and provide protection of respiratory tracts during the general anesthesia.
Most often serves as the reason of carrying out an anesthesiology grant by the pregnant woman in the second trimester the emergency operative measures in various occasions. Considering a possibility of influence of the general anesthesia on fetation and also danger of aspiration complications, during this period it is also expedient to give preference to regional techniques of anesthesia, and among regional those techniques of techniques which are accompanied by use of smaller amount of local anesthetic. In need of carrying out the general anesthesia prevention of aspiration complications and protection of respiratory tracts is carried out. Participation of the obstetrician-gynecologist at a stage of preoperative preparation and in the course of postoperative maintaining the patient for the purpose of control of a condition of a uterus and a fruit is expedient.
The third trimester — the most frequent period when there is a request of pregnant women for the anesthesiology help as in this period the anesthesiologist takes active part at a labor pain relief, performance of Cesarean section and other obstetric operations and also in postoperative maintaining.
The labor pain relief is carried out as medicamentous general ways, and by means of carrying out regional anesthesia. The greatest distribution in the world was gained by the prolonged epidural analgesia, also recently wins popularity an intrathecal analgesia. Catheterization of an epidural space allows to control well a pain syndrome during the disclosure period and also to carry out regional anesthesia of operation of Cesarean section if in it there is a need. Careful planning of anesthesia, informing the woman and coherence of work of anesthesiology and obstetric and gynecologic service as conducting childbirth in the conditions of epidural anesthesia demands from obstetricians of a certain knowledge and skills is important. The intrathecal analgesia is technically simpler, but it is carried out in one stage.
At an anesthesiology grant during operation of Cesarean section carrying out as regional (spinal or epidural), and the general anesthesia is possible. Regional (as a rule, spinal) anesthesia has indisputable preferences before the general: the risk of aspiration complications decreases, the risk of failures at a trachea intubation (which at pregnant patients is technically more difficult) decreases, the negative impact of funds for the general anesthesia for a fruit is excluded. However spinal anesthesia is contraindicated at Cesarean sections of high extent of urgency when there is a direct threat of life of mother and/or a fruit, at blood coagulation disturbances, refusal of the patient and some other contraindications to spinal anesthesia. As the general, and spinal anesthesia at Cesarean section demands obligatory performing preoperative prevention of an aspiration syndrome. Epidural anesthesia at Cesarean section is used seldom, generally only now when by the time of drawing of the indication for Cesarean section the patient has already established and correctly working epidural catheter.