Yesterday, a sister sent me a picture like this:
Although I felt it was a bit unkind, I couldn't help but tell lies because of the handsome male doctor. In the end, I took the initiative to get into trouble because of my own pain. Sister Sa, I really couldn't help laughing!
It turns out that don’t lie to the doctor. In addition to having sex, having several miscarriages, you also have to tell your real weight!
I don’t know if you remember, before having a cesarean section, prepare a belt and urine bag. The first thing you do when you enter the operating room is to weigh and weigh your weight!
Although sometimes the weight requirements may not be so accurate, in the case of anesthesia, weight does affect the calculation of the dose of the drug used by the anesthesiologist .
Different surgery requires different anesthesia methods. If it is only a minor local surgery, only local anesthesia can be used. If it is a larger surgery, general anesthesia or intra-spinal anesthesia is required.
For example, during cesarean section, the most commonly used anesthesia method is intra-spinal anesthesia .
A cesarean section surgery does not mean that you want to do it immediately. In an emergency, when the mother undergoes cesarean section, the anesthesiologist often needs to undergo a series of medical history collection and physical examinations, such as:
review of pregnancy history, past medical history, allergies and anesthesia history. Physical examination should at least evaluate vital signs, airway, cardiopulmonary system and waist. If it is not an emergency cesarean section, you should also make sure you have sufficient fasting time before surgery.
Before emergency cesarean section, try to seize the time to comprehensively evaluate the mother. Routine laboratory examinations before cesarean section generally include blood type test and antibody screening ; when there is a high risk of severe bleeding or there are red blood cell antibodies, blood type test, antibody screening and cross-matching should also be repeated before cesarean section. Baseline hemoglobin, platelet count and coagulation function may be required as appropriate.
is different from many other surgeries. Sedatives are generally not used before cesarean section, because sedatives can pass through the placenta and may also cause the mother to forget. Therefore, sometimes, the anesthesiologist will comfort the mother during the operation to relieve the mother's tension and anxiety.
Available anesthesia methods for cesarean section include general anesthesia and intra-spinal anesthesia, the latter including spinal anesthesia, spinal anesthesia-epdural combined anesthesia (CSE), and epidural anesthesia .
Which anesthesia technique is chosen depends on maternal and fetal condition, coexistence of diseases, expected surgery time and difficulty of surgery, and whether an epidural or subarachnoid catheter has been placed.
Although peripheral nerve block is not recommended as the first-line anesthesia for cesarean section, it may also be used in rare cases. For example, if there is no time to undergo intra-spinal anesthesia, it is necessary to urgently open the abdomen and end the delivery. At this time, the surgeon may be supplemented with sedatives, opioids and local infiltration anesthesia.
General anesthesia VS Intra-spinal anesthesia
The first choice for cesarean section anesthesia is intra-spinal anesthesia. Intra-spinal anesthesia is used in more than 95% of cesarean sections in the United States and Canada. Compared with other anesthesia methods, mothers can be aware of their childbirth process in a wakeful state, and can also minimize mother's complications.
In addition, the advantages of intra-spinal anesthesia also include the ability to minimize intra-operative systemic drug exposure and fetal drug exposure . It not only does not require airway management tools, but also provides convenience for the use of intra-spinal opioids during postoperative analgesia, which is the "analgesic pump" used by many people after surgery.
However, women in some special circumstances may also need general anesthesia when having cesarean section:
For example, emergency cesarean section, there is no time to perform intra-spinal anesthesia, excessive bleeding or insufficient time to reach the anesthesia plane required for the surgery through the epidural catheter.Or the mother refuses or is unable to cooperate with intra-spinal anesthesia, and there are contraindications for intra-spinal anesthesia.
Is cesarean section anesthesia safe?
cesarean section anesthesia-related mortality rate is extremely low, and there seems to be no difference in mortality rates between general and regional anesthesia.
A retrospective study analyzed data from 1997 to 2002, with 56 deaths. The results showed that there was no significant difference in the mortality rate of cesarean section and regional anesthesia (6.5 cases/1 million vs 3.8 cases/1 million; RR 1.7, 95%CI 0.6-4.6).
However, compared with intra-spinal anesthesia, there may be more bleeding from cesarean section under general anesthesia.
A meta-analysis through three randomized trials that included a total of 436 mothers, it was found that compared with N-spinal anesthesia, the blood loss of cesarean section increased slightly compared with N-spinal anesthesia. There was also a randomized controlled trial of in 418 healthy mothers, , which showed that the postoperative hemoglobin level in the general anesthesia group was slightly lower than that in the NA group (10.40±1.39 vs 10.92±1.24).
When applying anesthetic drugs, the weight problem of the mother will be considered, such as obese mothers who are overweight BMI55m2/kg.
However, one thing is certain that the weight before going to the operating table cannot be concealed, because it will be weighed directly in the company of medical staff and then written in the case.
The reason why I lies with the doctor is that I am confused for a moment and I have to live a life of face.
Whether it wakes up too early because of underreporting weight or being dizzy because of overreporting weight, this is just a problem of anesthesia medication. After all, it is safe under the supervision of anesthesiologist.
However, if you hide other more important issues, it may be that life is at stake.
For example, Sister Sa has encountered it before and insisted on saying that she has no sex life, but after checking it, it was an incident of ectopic pregnancy .
If the pregnancy test was not insisted on being ruled out, if the ectopic pregnancy occurs in rupture and heavy bleeding, it may be a matter of life in minutes.
So sometimes, Sister Sa often says, don’t tell lies to the doctor, because if you can’t say it well, you may be just joking about your life.
No matter what a shameful thing it is, when you face a doctor, you are a patient, and the doctor is most concerned about only the condition. No qualified doctor will gossip or make fun of the patient for doing something difficult to say.
When judging the condition and taking relevant treatment measures, put aside unnecessary concerns, is the safest "way to save your life" to be honest with the doctor.
References:
[1]Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124:270.
[2]Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology 2005; 103:645.
