RU2700377C1 - Method of sevoflurane inhalation analgesia in spontaneous delivery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology and obstetrics, and can be used for anesthesia in spontaneous labor. That is ensured by inhalation administration of sevoflurane. Preparation is introduced with preserving the spontaneous respiration of the parturient woman constantly until attempts appears, changing the concentration of sevoflurane depending on the period of labor. Introduction of sevoflurane is initiated with development of regular labor activity, opening of uterine cleft 3–4 cm, preparation concentration 1.2–1.5 % in oxygen flow 5–6 l/min using semi-closed contour. In 8–10 minutes, concentration of the preparation is reduced to 1 %, and the oxygen flow is reduced to 3–4 l/min and the introduction is continued until the cervix is fully opened. Further, the concentration of the preparation is increased to 1.2–1.5 %, and the oxygen flow is increased to 5–6 l/min, and the introduction is continued until attempts are made. That is followed by switching to a discrete regimen of preparation starting 1–2 minutes before the contraction and terminating the contraction in the culmination period while preserving spontaneous breathing of the parturient at the concentration of preparation 1.5 % in the oxygen flow of 5–6 l/min until the eruption of the head.

EFFECT: method provides adequate anesthesia, gentle delivery, prevention of complications caused by high doses of anesthetic, due to obtaining stable concentration of anesthetic by inhalation during inhalation of sevoflurane-oxygen mixture, reduced consumption of anesthetic in semi-closed respiratory circuit.

1 cl, 3 tbl, 2 ex

Description

The invention relates to medicine, namely to anesthesiology, obstetrics, and can be used to anesthetize spontaneous labor.

The search for methods to protect the body from pain aggression led to the resumption of work on the study of non-invasive safe and effective methods of pain relief in labor, and inhalation analgesia in particular, which can be used both separately and in combination with other methods.

The known method of intermittent inhalation administration of sevoflurane 60 seconds before the start of the bout [A. Toscano, C. Pancaro, S. Giovannoni, G. Minelli, C. Baldi, G. Guerrieri, J.A. Crowhurst, V.A. Peduto International Journal of Obstetric Anesthesia (2003), 12, 79-82]. Sevoflurane in a concentration of 2-3 vol% on the evaporator was added to the oxygen-air mixture until the target concentration of anesthetic on expiration 1-1.5 vol% was reached. With an extraordinary uterine contraction, the concentration of sevoflurane on the evaporator increased to 4-5 vol% for three consecutive breaths, and then decreased to 2 vol% to achieve the required concentration of anesthetic on exhalation of 1-1.5 vol%. In order to determine the effective concentration of sevoflurane, the Dixon method [Dixon WJ. The up and down methods for small samples. J Am Stat Soc 1965; 60: 967-978.]: If the concentration on the exhalation did not provide adequate analgesia, the concentration on the inspiration was increased by 0.5 vol% before the next bout. Conversely, if drowsiness occurred during labor, the concentration of sevoflurane on inspiration was reduced by 0.5% during the next reduction.

The disadvantages of the method include the lack of a selected effective concentration of anesthetic, and its high consumption. The proposed technique requires the constant presence of an anesthetist. In 4 women in childbirth due to the use of high concentrations of sevoflurane, excessive drowsiness was noted.

To determine the effective concentration of sevoflurane during anesthesia of spontaneous labor, a method was proposed for a step-by-step increase in the concentration of inhalation anesthetic with each contractions: the woman in labor began by inhaling the oxygen-air mixture with the first contractions, and then the added concentration of sevoflurane on the evaporator increased by 0.2 vol% for each subsequent reduction to achieve a maximum concentration of sevoflurane 1.4 vol%. If a woman in labor had difficulty understanding the question and assessing it using a visual analogue scale, this was recorded as “excessive sedation” and the concentration of sevoflurane decreased by 0.2% for the next fight [S.T. Yeo, A. Holdcroft, S.M. Yentis, A. Stewart Analgesia with sevoflurane during labor: I. Determination of the optimum concentration, British Journal of Anaesthesia 98 (1): 105-9 (2007)]. Thus, the inspiratory sevoflurane concentration of 0.8% was determined to be effective for the analgesia of spontaneous labor.

Among the main disadvantages of this method, it is necessary to note the impossibility of full control of the concentration of anesthetic during the inhalation period. Achieving a fixed concentration of sevoflurane on inhalation using a mini-vaporizer is a problem, since intensive (forced) breathing changes the concentration of the anesthetic. There is a need for regulation by medical personnel (anesthetist, anesthetist, midwife) of the respiratory rate of the woman in labor during each bout. The main complication in women in labor was excessive sedation when the concentration of sevoflurane on the mini-evaporator reached 1.2 vol%.

There is also known a method of analgesia of spontaneous labor, in which a comparison of the effectiveness of the concentration of sevoflurane on inspiration of 0.8 vol% and a mixture of entonox (nitrous oxide: oxygen = 50%: 50%) for inhalation analgesia in the first stage of labor [S.T. Yeo, A. Holdcroft, S.M. Yentis, A. Stewart, P. Bassett Analgesia with sevoflurane during labor: II. Sevoflurane compared with Entonox for labor analgesia, British Journal of Anaesthesia 98 (1): 110-15 (2007)]. In this method, a discrete mode of administration of the inhalation mixture from the beginning to the peak of the contractions was used.

The main disadvantage of this method is the inability to achieve a stable concentration of inhaled anesthetics during childbirth due to the intermittent nature of the application of this technique, which follows intermittent pain in a woman in labor. For ethical reasons, if effective pain relief is not achieved, the woman in labor was given the opportunity to skip the non-respiratory phase.

As a prototype, we chose a method of analgesia during spontaneous labor, which suggested inhalation analgesia by sevoflurane in labor with intermittent management of this anesthetic [Ng, K. W. S .; Chan, Y .; Shariffuddin, I. I .; Yim, S. S. W .; Md Latar, I. L .; Eltringham, R .; Moy, Y. Abstract PR210: Sevonox Study A Comparison of 0.8% Sevoflurane & Entonox for Labor Analgesia. Anesthesia & Analgesia: September 2016 - Volume 123 - Issue 3S_Suppl - p 265-266.].

In the prototype method, it is impossible to achieve a stable concentration of inhaled anesthetics during childbirth, which reduces the quality of the analgesia.

Thus, analyzing the few works devoted to the use of inhalation analgesia in spontaneous births based on sevoflurane, it should be noted that all researchers used only a discrete regimen of anesthetic administration, the use of high concentrations of sevoflurane in childbirth can adversely affect the body of the mother, fetus and newborn, as well as on perinatal and obstetric outcomes.

The technical problem is the development of a universal, optimal and effective technique for inhalation analgesia with sevoflurane in spontaneous births.

The technical result achieved by the implementation of the invention is to provide adequate analgesia for spontaneous labor, the prevention of complications caused by high doses of anesthetic due to the lack of objective control over the values of the mentioned doses, as well as the exclusion of anesthetic losses due to the original regimen of inhalation of sevoflurane taking into account the period of delivery, the nature of labor through continuous administration of an inhaled anesthetic and the use of a hermetic facial mask for non-invasive use lung ventilation;

Patented method allows to obtain a stable concentration of anesthetic on inhalation during inhalation of sevoflurane-oxygen mixture; reduce anesthetic consumption by transferring a half-open respiratory circuit to a half-closed.

We have found that subanesthetic doses of sevoflurane administered to women in labor continuously during spontaneous delivery allow adequate analgesia to be achieved in the shortest possible time. The lack of influence on the physiology of contractions allows the use of the inhaled anesthetic sevoflurane in both the first and second periods of childbirth, without fear of an adverse effect on the body of the mother, fetus, newborn.

A regular breathing pattern and a continuous mode of administration of an inhaled anesthetic allow you to establish a constant concentration of sevoflurane on inhalation during inhalation, eliminate losses and, accordingly, a large consumption of anesthetic and ensure reliable pain relief during spontaneous delivery.

The invention consists in the following.

The method of analgesia during spontaneous birth includes inhalation administration of sevoflurane. In this case, the introduction of the drug is carried out while maintaining spontaneous breathing of the woman in labor constantly until the appearance of attempts, changing the concentration of sevoflurane depending on the period of delivery. The introduction begins with the development of regular labor, the opening of the uterine pharynx 3-4 cm, the concentration of the drug 1.2-1.5% in the flow of oxygen 5-6 l / min, using a half-closed circuit. After 8-10 minutes, reduce the concentration of the drug to 1%, and the flow of oxygen to 3-4 l / min and continue administration until the cervix is fully opened. Then again increase the concentration of the drug to 1.2-1.5%, and the oxygen flow to 5-6 l / min and continue the introduction until the appearance of attempts. Then they switch to a discrete regimen of drug administration, starting 1-2 minutes before the contractions and stopping during contractions while maintaining spontaneous breathing of the woman in labor at a concentration of 1.5% in the oxygen flow of 5-6 l / min until the head erupts.

Inhalation administration of sevoflurane is carried out using a sealed face mask for non-invasive mechanical ventilation.

The method is as follows:

The preparation of women in labor for the upcoming analgesia consists in conducting an anesthesiologist’s conversation, during which they ascertained the severity of the concomitant pathology, the characteristics of the past anesthesia, explained the plan for the upcoming anesthetic management, explained the advantages and disadvantages of the inhalation method for pain relief in labor, as well as the possibility of the most probable complications during inhalation analgesia. Premedication before inhalation analgesia is not required. To conduct analgesia, it is necessary to collect a half-closed respiratory circuit, fix the mask for non-invasive artificial ventilation of the lungs on the face.

The introduction of the sevoflurane-oxygen mixture is carried out against the background of preserved spontaneous breathing by constant inhalation (during and between contractions), setting the oxygen flow 5-6 l / min and the concentration of sevoflurane on the evaporator 1.2-1.5%.

The medical staff concentrates the parturient's attention on the correct breathing: the parturient woman begins to deeply and evenly inhale the gas mixture with the appearance of contractions, from the moment the contractions decrease and in the interval between contractions the breathing becomes more superficial, calm and even, the parturient is asleep between contractions.

Target sedation rate on the Ramsey II-III scale. Control the state of consciousness of the woman in labor, pulse oximetry data, respiratory rate and depth, cardiotocography data (CTG).

After 8-10 minutes from the start of inhalation of the sevoflurane-oxygen mixture, the oxygen flow is reduced to 3-4 l / min, the concentration of sevoflurane on the evaporator is reduced to 1%. As the frequency and strength of contractions increases, in order to exclude violations of the breathing technique, it is important for medical personnel to remind and periodically monitor the correct breathing of the woman in labor. Recommended sedation level on the Ramsey II-III scale.

To ensure effective analgesia in the second stage of labor (complete opening of the uterine pharynx), the oxygen flow is increased to 5-6 l / min, the concentration of sevoflurane on the evaporator is increased to 1.2-1.5 vol%. Inhalation of the sevoflurane-oxygen mixture is continued continuously. If it is necessary to carry out attempts, it is necessary to switch to a discrete mode of administration: inhalations begin 1-2 minutes before the bout and stop during the period of its culmination when the woman in labor is pushing. To ensure effective analgesia, the oxygen flow is maintained at the level of 5-6 l / min, the concentration of sevoflurane on the evaporator is 1.2-1.5%.

To prove the possibility of realizing the claimed purpose and achieving the specified technical result, we provide the following data.

The specified method was used to anesthetize spontaneous labor in 33 women in labor. The average duration of inhaled analgesia was 92.1 ± 28 minutes. There were no failures, transitions to another variant of anesthesia. 15 minutes after the start of inhalation with sevoflurane, there was a statistically significant decrease in the intensity of the pain syndrome according to YOUR data by 32% of the initial values (p <0.01), corresponding to the assessment of pain as “moderate”. The indicated trend continued for 60 minutes from the start of analgesia. Given that the inhalation analgesia used by sevoflurane has not only an analgesic, but also a hypnotic effect, we evaluated the level of sedation depth on the Ramsey scale and the degree of stimulation-sedation on the Richmond scale (RASS). Throughout the entire period of inhalation analgesia, the sedation level on the Ramsey scale corresponded to II-III [2.64-2.21], on the RASS scale did not exceed (-1) [(-0.27) - (- 0.64)] , oppression of the laryngeal pharyngeal reflexes was not observed.

All puerperas showed a normal course of spontaneous childbirth (taking into account strength, frequency of contractions, analysis of partograms, duration of periods of childbirth) (Table 1-2). Blood loss in childbirth was 177.4 ± 50.5 ml, excess of allowable blood loss and bleeding in childbirth and the early postpartum period was not observed. All patients were discharged on the 4th day home in satisfactory condition.

All children were discharged home in satisfactory condition on the 4th day. 32 (97%) newborns had a neurological status without pathology (according to the profile of oppression-irritation A.B. Palchik, 1993), in 1 (3%) newborn, neurosonography (NSG) showed an increase in the resistance of cerebral vessels on the first day of the neonatal period due to chronic intrauterine hypoxia of the fetus in combination with intrauterine infection, which is confirmed by changes in the R-gram of the abdominal organs (enlargement of the intestinal loops detected by pyeloectasia with ultrasound of the kidneys), an increase in the level of C-reagent protein up to 6.5 mg / l, leukopenia.

Nevertheless, the use of inhalational analgesia with sevoflurane for pain relief gave birth to a more gentle delivery of the child with perinatal pathology and positive dynamics by the end of the early neonatal period: the child was born with a high rating on the Apgar scale, did not require primary resuscitation measures and was discharged on the 4th day home.

The obtained indicators of the acid-base and gas composition of blood from the artery and vein of the umbilical cord at birth (n = 16, Table 3) are within acceptable values, which indicates the absence of intrauterine hypoxia when inhalation analgesia is given by sevoflurane and is additionally confirmed by the normal level of fetal hemoglobin ( HbF 88.5 ± 5.7%). Capillary test values correspond to compensated metabolic acidosis, which is the norm at 5 minutes of life of newborns. Table 3 presents the indicators of the acid-base and gas composition of blood in infants immediately after birth and at 5 minutes of life during inhalation analgesia with sevoflurane (M ± σ) according to the proposed method.

The presented materials testify to the effectiveness of the inhalation application of sevoflurane and a reversible respiratory contour with a face mask for non-invasive mechanical ventilation. The proposed variant of inhalation analgesia has demonstrated not only its effectiveness for the analgesia of spontaneous labor, but also safety for the mother and the fetus.

The above information confirms the possibility of using the claimed method of inhalation analgesia with sevoflurane, which can be used in obstetric practice to ensure effective pain relief in women in labor in the first and second periods of childbirth.

Clinical example 1.

Multiparous I., 35 years old 10/05/17 at 08:40 transferred to programmed childbirth.

Objectively: The condition is satisfactory. No complaints at the time of inspection. No headache. Clear vision. The skin of normal color, clean. Ps - 80 beats / min, rhythmic, blood pressure - 120/70, 120/80 mm. Hg The uterus is excitable, painless on palpation in all departments. The position of the fetus is longitudinal. The fetal head is pressed to the entrance to the pelvis.

The fetal heartbeat is clear, rhythmic up to 144 beats per 1 minute. Physiological administration is not disturbed. Estimated weight of the fruit is 3000-3200 gr.

Vaginal examination: External genitalia without visible pathology. The vagina is capacious, the mucous membrane is clean. The cervix along the axis of the pelvis, up to 1 cm long, soft, cervical canal passes 2 fingers freely. Slated to be the head of the fetus, pressed to the entrance to the small pelvis. No exostosis in the pelvis. Discharge mucous, bright. Con.diagonalis - 12.5 cm.

Diagnosis: Pregnancy 38-39 weeks. Head presentation. Cicatricial deformity of the cervix. Mild anemia. Low water. Pyeloectasia in the fetus on the left.

10/05/17, at 08:40 in aseptic conditions, under the control of the obstetrician’s arm, the fetal bladder was opened with an amniotome. 200 ml of clear amniotic fluid were poured. The head is pressed to the entrance to the pelvis. The fetal heartbeat is clear, rhythmic up to 146 / min.

10/05/17 at 11:20 Regular labor activity from 09 h 00 min. The condition is satisfactory. No headache. Clear vision. Complaints of painful contractions. AD-110/80; AD-110/70 mm Hg Pulse 80 per minute. Contractions after 2.5-3 minutes, 30-35 seconds each, of sufficient strength, painful. The uterus between contractions relaxes completely. The heartbeat of the fruit is clear, rhythmic, 146 / minute.

Vaginal examination: The cervix is flattened, the edges are moderately soft. Opening 4-5 cm. There is no fetal bladder. The fetal head is pressed to the entrance to the pelvis. Arrow-shaped seam in right oblique size: small fontanel on the left at the womb, large fontanel on the right at the sacrum. Highlight bright water. Taking into account painful contractions, it was decided to apply inhalation analgesia with sevoflurane in accordance with the proposed method.

12

Inspected by an anesthetist. According to a general examination, survey, laboratory and instrumental examination data, physical status II (ASA) was set. A psycho-preventive conversation was carried out, what sensations were explained and in what sequence will appear as the gas mixture is inhaled (state of drowsiness, drowsiness, relaxation, dulling of all sensations, alienation of the body), the attention of the woman in labor is focused on the constant presence of the mask and the need to observe the breathing technique depending on the presence of / lack of contractions. The intensity of the pain syndrome according to YOUR 60, the level of excitement according to RASS (Richmond (+1) scale for the assessment of excitation-sedation. Anesthesia was performed according to the proposed method.

10/05/17, at 11:30 The respiratory circuit was assembled, a facial mask for non-invasive ventilation of the face was fixed. Inhalation analgesia was started by continuous administration of sevoflurane-oxygen mixture: an oxygen flow of 6 l / min was established, the concentration of sevoflurane on the evaporator was 1.5%. Under the supervision of an anesthesiologist, the woman in labor deeply and evenly inhales the gas mixture with the appearance of the precursors of the contractions to its peak. From the moment of reducing the strength of the contractions and in the interval between contractions, the respiratory rate decreases, breathing is more superficial and even.

11:40 Level of sedation on the Ramsey III scale, level of stimulation-sedation on RASS (-1). A woman in labor is taking a nap between contractions; she is easily awakened in response to commands, AD-108/62; HELL - 91/58 mm RT. Art., pulse 101-84 beats / min, SpO ₂ 97-99%. The intensity of the pain syndrome according to YOUR 40. According to CTG: basal rhythm 149, variability of 7.5, the amplitude of contractions 80-88.

11: 38-13: 00 Inhalation of the sevoflurane-oxygen mixture continues in a constant mode, the oxygen flow decreases to 3 l / min, the concentration of sevoflurane on the evaporator decreases to 1%. Level

 sedation on the Ramsey III scale, the level of excitation-sedation according to RASS (-1), preserved oral fluid intake by the mother in childbirth. A woman in labor is napping between contractions, AD-103/64; HELL - 97/53 mm Hg Pulse 98-82 bpm, SpO2 97-99%. The intensity of the pain according to YOUR 40-50-55. CTG without pathology.

13:00 With vaginal examination - complete opening of the cervix. To ensure effective analgesia, the oxygen flow is increased to 5 l / min, the concentration of sevoflurane on the evaporator increases to 1.5%. Inhalation of the sevoflurane-oxygen mixture continues continuously. The sedation level on the Ramsey I scale, the level of excitation-sedation according to RASS 0, AD-110/60; HELL - 115/73 mm Hg Pulse 96-84 bpm, SpO2 98-99%. The intensity of the pain syndrome according to YOUR 75. CTG without pathology.

10/05/17 at 13:10 The condition is satisfactory. HELL 120/70, 150/70, pulse 86-92 beats / min, rhythmic. Attempts began for 40 seconds after 2 minutes, moderately painful, of sufficient strength, the fetal head sank to the pelvic floor - crashes. The fetal heartbeat is clear, rhythmic 146 beats / minute. To ensure effective inhalation analgesia, the oxygen flow remains at the level of 5 l / min, the concentration of sevoflurane on the evaporator is 1.5%, the mode of administration of the mixture is discrete: inhalation begins 1-2 minutes before the contractions and stops during the climax, when the woman in labor is pushing.

10/05/17 at 13:20 in the front view of the occipital previa was born a live, full-term boy weighing 3600 g, 51 cm long, with an Apgar scale rating of 8-9 points, without visible malformations. The child is referred to a neonatologist. Urine excreted by the catheter is light.

10/05/17 at 13:25 The placenta independently separated and the placenta was isolated with all lobules and fetal membranes, size 15 × 14 × 2.0 cm, weighing 500 g. The length of the umbilical cord is 70 cm. The uterus is dense with clear contours, blood discharge moderate. Cold on the lower abdomen. Blood loss 100.0 ml.

Clinical example 2.

Multiparous K., 34 years old, 06/28/17, 03:00: complaints of cramping pains in the lower abdomen from 00.30 - not painful, did not contact the staff; on the outflow of amniotic fluid. The night slept intermittently.

Objectively: The condition is satisfactory. The head does not hurt. Vision is clear. The skin of normal color, clean. Ps - 76 bpm, rhythmic, blood pressure - 110/70, 100/70 mm. Hg Contractions for 25-25 seconds after 5 minutes, moderately painful, of sufficient strength. The position of the fetus is longitudinal. The fetal head is pressed to the entrance to the pelvis. The fetal heartbeat is clear, rhythmic up to 140 beats per 1 minute.

Diagnosis: Pregnancy 39 weeks. 1 position anterior view of the occipital presentation. I period of childbirth. Bronchial asthma of mixed origin, controlled. Obesity. Swelling caused by pregnancy. Colpitis. Amniotic fluid outflow.

Vaginal examination: The cervix is flattened, the edges are moderately soft. Opening 4-5 cm. There is no fetal bladder. The fetal head is pressed to the entrance to the pelvis. Arrow-shaped seam in right oblique size: small fontanel on the left at the womb, large fontanel on the right at the sacrum. Highlight bright water. Taking into account painful contractions, it was decided to apply inhalation analgesia with sevoflurane in accordance with the proposed method.

10/05/17, at 03:00 Inspected by an anesthetist. According to a general examination, survey, laboratory examination data, physical status III (ASA) was set. A psychoprophylactic conversation was carried out, what sensations and in what sequence will appear as the gas mixture is inhaled, the attention of the woman in labor is focused on 15

the constant presence of the mask and the need to follow the breathing technique, depending on the presence / absence of contractions. The intensity of the pain syndrome according to YOUR 65, the level of excitement according to RASS (Richmond (+1) scale for the assessment of excitation-sedation. Anesthesia was performed according to the proposed method.

10/05/17 at 03:10 The respiratory circuit was assembled, a facial mask for non-invasive mechanical ventilation on the face was fixed. The continuous introduction of the sevoflurane-oxygen mixture has begun: an oxygen flow of 6 l / min has been established, the concentration of sevoflurane on the evaporator is 1.5%. Under the supervision of an anesthesiologist, a woman in labor is deeply and evenly inhaling the gas mixture.

03:20 Sedation level on the Ramsey III scale, level of excitation-sedation on RASS (-1). laryngeal pharyngeal reflexes preserved. A woman in labor is napping between contractions, AD-115/59 mmHg. Art. Pulse 88-92 bpm, SpO ₂ 98-99%. The intensity of the pain syndrome according to YOUR 42. According to CTG: basal rhythm 142, variability 5.1, the amplitude of contractions 88-90.

03: 20-04: 00 Inhalation of the sevoflurane-oxygen mixture continues continuously, the oxygen flow decreases to 3 l / min, the concentration of sevoflurane on the evaporator decreases to 1%. The sedation level according to the Ramsey III scale, the level of excitation-sedation according to RASS (-1), the laryngeal pharyngeal reflexes are preserved. A woman in labor is napping between contractions, AD-114/70 mmHg. Art. Pulse 76-84 bpm, SpO2 97-99%. Intensity of pain according to YOUR 40-45. CTG without pathology.

04:00 With a vaginal examination - complete opening of the cervix. To ensure effective analgesia, the oxygen flow is increased to 5 l / min, the concentration of sevoflurane on the evaporator increases to 1.5%. Inhalation of the sevoflurane-oxygen mixture continues continuously. The sedation level on the Ramsey I scale, the level of excitation-sedation according to RASS (+1), AD-10/65; HELL - 15/76 mm RT. Art. Pulse

 92-84 bpm, Sp02 98-99%. Intensity of pain according to YOUR 80. CTG without pathology.

06/28/17 g 04:30 The condition is satisfactory. HELL 110/70, 110/70, pulse 86 beats. in 1 minute, rhythmic. The fetal head sank to the pelvic floor - crashes, attempts began for 40-45 seconds after 1-2 minutes, moderately painful, of sufficient strength. C / b of the fetus is clear, rhythmic in CTG up to 132 beats. in 1 minute. To carry out inhalation analgesia during attempts, the oxygen flow is maintained at 6 l / min, the concentration of sevoflurane on the evaporator is 1.5%, a discrete administration regimen has been started: 1-2 minutes before the contractions and before its climax, when the woman in labor is pushing.

06/28/17, 04:40 in the front view of the occipital presentation, a lively, full-term girl was born, weighing 3800 g, 51 cm long, with an Apgar score of 8-9 points. There was a single, tight, cord entwining around the neck of the fetus. At the time of eruption of the parietal tubercles in / in introduced 1.0 oxytocin. Urine excreted with a catheter - light 50.0 ml.

06/28/17, 04:45 The placenta independently separated and the placenta was separated with all lobules and fetal membranes, 16 × 16 × 3 cm in size, weighing 500 g. The length of the umbilical cord is 55 cm. The uterus is at the level of the navel, dense. Cold on the lower abdomen. Blood loss 100.0 ml.

Thus, the proposed method for inhalation analgesia with sevoflurane allows:

- to achieve rapid induction and efficiency in a short time;

- eliminate the effect on the physiology of contractions;

- to conduct adequate analgesia in both the first and second periods of childbirth by means of a constant regimen of administration of an inhalation anesthetic up to attempts with a transition to a discrete regimen of inhalation;

- determine the optimal time and duration of use of an inhaled anesthetic relative to the period of labor and the nature of labor, the dose of an inhaled anesthetic, the mode of administration, the necessary oxygen flow;

- to ensure the achievement of a stable concentration of sevoflurane on inhalation during inhalation of the sevoflurane-oxygen mixture;

- reduce the consumption of anesthetic by translating a half-open respiratory circuit into a half-closed, which allows to reduce the flow of oxygen at the main stage of maintaining analgesia.

Claims (2)

1. A method of analgesia during spontaneous labor, including inhaled administration of sevoflurane, characterized in that the administration of the drug is carried out while maintaining spontaneous breathing of the woman in labor until the appearance of attempts, changing the concentration of sevoflurane depending on the period of delivery; in this case, the introduction begins with the development of regular labor, the opening of the uterine pharynx 3-4 cm, the concentration of the drug 1.2-1.5% in the oxygen flow 5-6 l / min, using a half-closed circuit; after 8-10 minutes, reduce the concentration of the drug to 1%, and the flow of oxygen to 3-4 l / min and continue administration until the cervix is fully opened; then again increase the concentration of the drug to 1.2-1.5%, and the oxygen flow to 5-6 l / min and continue the introduction until the appearance of attempts; then they switch to a discrete regimen of drug administration, starting 1-2 minutes before the contractions and stopping during the culmination of contractions while maintaining spontaneous breathing of the woman in labor at a concentration of 1.5% in the oxygen flow of 5-6 l / min until the head erupts. 2. The method according to p. 1, characterized in that the inhaled administration of sevoflurane is carried out using an airtight facial mask for non-invasive mechanical ventilation.