Журнал «Медицина неотложных состояний» Том 19, №2, 2023

Актуальність. Кесарів розтин залишається одним із найчастіших оперативних втручань у всьому світі. Основними недоліками загальної анестезії при кесаревому розтині є: високий рівень ймовірності збереження свідомості під час операції і виражена гемодинамічна реакція на операційну травму у пацієнтки. Найнебезпечнішим періодом оперативного втручання щодо виникнення цих ускладнень є період до народження дитини. У статті проведено аналіз власних клінічних випадків загальної анестезії при кесаревому розтині з додаванням ад’ювантів та порівняння анестезіологічного менеджменту зі світовими практиками. У всіх випадках власної клінічної практики проводилась тотальна внутрішньовенна анестезія зі штучною вентиляцією легень. Як ад’юванти було застосовано внутрішньовенні форми медичних препаратів: парацетамол (1000 мг) і клонідин (100 мкг) за 30 хвилин до планового оперативного втручання. Проводилась оцінка новонародженого за шкалою Апгар і аналіз газів пуповинної венозної крові. Передопераційний, інтраопераційний та післяопераційний менеджмент пацієнтів базувався на рекомендаціях з раннього відновлення після операції кесаревого розтину та рекомендаціях робочої групи PROSPECT. Результати аналізу власних клінічних випадків: виявилено наявність гемодинамічної реакції організму пацієнта на операційну травму (у періоді до народження дитини), що не перевищує безпечні рівні; відсутність анестезіологічних ускладнень та випадків збереження свідомості пацієнта під час оперативного втручання; відсутність негативного впливу ад’ювантів на новонароджених; достатній рівень глибини анестезії та зменшення доз застосованих інтраопераційно наркотичних анальгетиків і внутрішньовенних анестетиків («на потребу пацієнта»). Висновки. Аналіз клінічних випадків аргументує необхідність застосування «безпечних ад’ювантів» (ацетамінофен, клонідин) до загальної анестезії при плановому кесаревому розтині та необхідність подальших досліджень.

Background. Caesarean section remains one of the most common surgical interventions in the world. The main disadvantages of the general anesthesia in caesarean section are a high risk of awareness during the operation and a pronounced hemodynamic reaction to the surgical trauma in a patient. The most dangerous period of intervention in terms of these complications is the period before the birth of a child. This article analyzes our own clinical cases of the general anesthesia during elective caesarean section with the addition of adjuvants and compares anesthetic management with world practices. In all cases from our own clinical practice, total intravenous anesthesia with artificial lung ventilation was performed. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg) and clonidine (100 μg), 30 minutes before the elective surgical intervention. The newborns were examined with the Apgar scale and umbilical venous blood gas analysis was carried out. Preoperative, intraoperative, and postoperative management of patients was based on recommendations of the Enhanced Recovery After Caesarean Section and guidelines of the PROSPECT working group. Results. The analysis of our own clinical cases revealed the presence of a hemodynamic reaction of the patient’s body to the operative injury (in the period before the birth of a child), which does not exceed safe levels; absence of anesthetic complications and cases of accidental awareness during surgery; absence of a negative influence of adjuvants on newborns; sufficient depth of anesthesia and reduction of the intraoperative doses of opioids and intravenous anesthetics (“on patient’s request”). Conclusions. The analysis of clinical cases argues for the need to use “safe adjuvants” (acetami­nophen, clonidine) to general anesthesia during elective caesarean section and the necessity for further research.

загальна анестезія; тотальна внутрішньовенна анестезія; штучна вентиляція легень; кесарів розтин; клонідин; ацетамінофен

general anesthesia; total intravenous anesthesia; artificial lung ventilation; caesarean section; clonidine; acetaminophen

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