Anesthesia method for cesarean section

In fact, the most important thing for cesarean section is to get anesthesia before the operation. This is very critical. If the anesthesia is not done well, it will cause a lot of problems. In addition, there are many ways of anesthesia, but it is safer to choose semi-anesthesia. In this way, the risk factor will be relatively small, and it can also make the fetus in the abdomen easier to deliver.

(1) Incision of the abdominal wall: After the surgical site is determined, the surgeon will clean, shave, disinfect, and anesthetize the area as usual. First, an arc-shaped incision will be made. Then, the skin and muscles, external oblique muscles, internal oblique muscles, transverse abdominal muscles, and their fascia will be incised in layers. Any blood vessels should be avoided or double ligated. Then cut the peritoneum. When cutting the abdomen, you must use tweezers to pick it up and cut a small hole. Then the operator inserts the middle finger or index finger of the left hand into the incision, and under the guidance of the left hand, cut the peritoneum to the appropriate length to expose the rumen.

(2) Pulling out the uterus: After the peritoneum is incised, the surgeon's arm should be disinfected again and rinsed with saline, then inserted into the abdominal cavity to examine the uterus, fetus and nearby organs to check for rupture and adhesion. Then have an assistant move the rumen forward to expose the uterus. The pessary is pushed out of the incision. When pulling the uterus, move slowly and at an angle. Excessive force can easily tear the uterus. After the uterus is pulled out, a large piece of multi-layer sterile gauze should be placed between the uterus and the edge of the incision to prevent the fluid in the uterus from flowing into the abdominal cavity and causing infection.

(3) Uterine incision: After identifying the greater curvature of the uterine horn, avoid the uterine caruncle and cut through the uterine wall with one cut. After fully ligating the bleeding point of the uterine wall incision, carefully separate the fetal membrane near the incision. If the membrane is full of amniotic fluid, make a small cut to release the amniotic fluid first. Choose the appropriate location and direction for releasing the tire water. After part of the amniotic fluid has been released, use scissors to extend the amniotic membrane incision and flip the cutting edges on both sides toward the sides of the uterine incision and fix them. In this way, the cutting edges of the everted amniotic membrane form a biological wound, and the amniotic fluid will not leak into the abdominal cavity when it flows out, causing contamination.

(4) Pulling out the fetus: When removing the fetus, grasp the tarsal part of the fetus' hind limb or the wrist of the forelimb along the uterine incision and slowly pull the fetus out in the most suitable direction and angle. If the incision is too small, it can be enlarged. After pulling out the fetus, the assistant should secure the uterus to prevent it from retracting into the abdominal cavity. The pulled out fetus is cared for as a calving cow.

(5) Peeling off the placenta: The principle of treatment is that if it can be peeled off, it should be completely peeled off. If it cannot be peeled off, the fallen part should be cut off, and the rest should be left in the uterus to fall off and be discharged on its own. However, the fetal membranes near the edges of the incision must be peeled off and cut off, otherwise it will hinder the suture.

(5) Suturing the uterus: Before suturing the uterus, anti-inflammatory powder should be evenly spread inside the uterus. The uterus is usually closed with two sutures, the first is a full-thickness continuous suture, and the second is a serosal and muscular layer embedding suture. In order to accelerate uterine healing and hemostasis and facilitate the discharge of lochia, 5 to 10 units of posterior pituitary hormone can be injected into the uterine cavity before suturing.