Guidance on anaesthesia and post-operative care for extrauterine pregnancy
I. Anaesthesia of extrauterine pregnancy
(i) Purpose of anaesthesia of extrauterine pregnancy
1. Pain
Out-of-court pregnancy can cause obvious pain, especially when dealing with pathologies, such as tubing. An effective anaesthesia removes or alleviates the pain of the patient during the operation and allows the patient to undergo surgery in a relatively comfortable state. If pain is not controlled, it can lead to severe pain stress and affect surgery and the patient ‘ s physical condition.
Muscles loose
During the operation, good muscle laxity is essential for the operation to proceed smoothly. Whether abdominal or abdominal surgery, muscle laxity can provide a better operational vision and operating space for the surgeon. For example, in the case of abdominal cavity surgery, the laxity of appropriate muscles facilitates the establishment of abdominal and equipment flexibility to allow for the accurate treatment of extrauterine pregnancy.
3. Maintenance of physical stability
Many patients with extra-uterine pregnancies may suffer from pre- and shock due to internal abdominal bleeding. Anesthesia helps to regulate the physical function of the patient, such as cardiovascular, respiratory, and stabilize vital signs such as blood pressure, heart rate, respiratory frequency, etc. This not only ensures safe operation, but also reduces further physical damage caused by the operation and the patient ‘ s own condition.
(ii) Anaesthesia methods commonly used in extrauterine pregnancy operations
1. General anesthesia
– Intravenous whole-body anesthesia: common drugs such as propol, itomite, etc. Properol has a fast-acting, fast-awakening and complete character. It enables the patient to rapidly enter anaesthesia and to wake up more quickly after the surgery and to facilitate the recovery of the patient after the surgery. It is less inhibitive of the cardiovascular system and is applied to patients with ectomethane who are in shock or are suffering from unstable blood flow mechanics. The operation of anaesthesia in the whole of the veins is relatively simple, but the regulation of the depth of anaesthesia requires extensive experience by an anesthesiologist, as it is mainly dependent on the accuracy of the dose. – Inhalation of whole body anesthesia: The usual inhalation of anesthesia is heptafluoro-, hexafluoro-, etc. By inhaling anaesthesia, the drug enters the blood cycle through pulmonary bubbles and acts on the central nervous system. Inhalation of anaesthesia has the advantage of prompting and awakening, and the depth of anaesthesia can be easily reconciled. During the operation, the anesthesiologist may adjust the depth of the anesthesia in a flexible manner in accordance with the procedure. Inhalation of anaesthesia, however, requires special anaesthesia equipment, such as an anaesthesia machine, and the patient may have adverse effects such as nausea and vomiting after the operation.
2. Intravertebrates
– Leprosy: It’s the injection of impregnatives into the lower cavity of the spider. The sterosophy that is often used in extrauterine pregnancy operations is in Bubikaine and others. The virtues of lumbar anaesthesia are that it works quickly, that it provides a good abdominal aesthetic effect and that the muscles are loose. However, it also has a number of complications, such as the potential for low blood pressure, as a result of the expansion of the lower limbs after anaesthesia and the redistribution of blood. In addition, some patients may have post-operative headaches, which are associated with a puncture needle injury to the spinal lobe and a brain leak.
– Extradural anaesthesia: E.D.D. is injected into the epidural gap. It can continue to be administered in accordance with the needs of the operation and the extent of the anesthesia can be adjusted to some extent. It is more appropriate for extra-uterine pregnancy, which is relatively stable and has a slightly longer operation. However, epidural anaesthesia is relatively slow and may sometimes lead to incomplete anaesthesia, requiring timely adjustment of the anesthesia programme.
3. Partial anaesthesia: it is generally used less separately for ecstasy than for ecstasy, most when the patient is in a state of emergency, such as severe shock, and is unable to withstand a general anesthesia or intravertical anesthesia. For example, in case of an emergency requiring a rapid stop to the bleeding, vasectomy may be performed under local immersion. However, local anaesthesia does not completely eliminate the pain and fear of the patient, and the operation is limited by the possibility that the patient may move his or her body unconsciously in a state of soberness.
(iii) Pre-aesthetic preparation and assessment
1. Patient assessment – Life signs assessment: Anesthetists are required to provide detailed information on the basic vital signs of blood pressure, heart rate, breathing and body temperature. The extent of the shock needs to be accurately assessed for patients who already have a state of shock, such as by measuring blood pressure, observing the patient ‘ s spirit, skin colour and temperature, urine, etc. For cases of shock, measures such as quick rehydration, blood transfusion, etc. should be taken as soon as possible to improve the patient ‘ s tolerance for anaesthesia.
– Estimation of haemorrhage: Internal haemorrhage in the abdominal cavity is assessed by the patient ‘ s clinical performance, such as pale color, dizziness, panic, the severity and nature of abdominal pain, and abdominal ultrasound results. Mass haemorrhage can seriously affect the circulatory function of the patient and the safety of the anesthesia, requiring adequate preparation prior to anaesthesia.
– Ask about the history of the disease: ask for details about whether the patient has chronic diseases such as cardiovascular diseases, respiratory diseases and diabetes, which may affect the choice of anaesthesia and the management of anaesthesia. At the same time, it is understood whether the patient has an anaesthesia history, an allergy history of drugs, etc., and avoids the use of narcotic drugs that can cause allergies or adverse reactions.
2. Preparation for anaesthesia
– Preparation of patients: prior to anaesthesia, the patient is required to strictly fast water, with a general fast of 6 – 8 hours and a water ban of 2 – 3 hours, in order to prevent the risk of vomiting, missuction, etc. during anaesthesia. At the same time, there is a need to establish effective ivory channels for patients, to facilitate infusion, blood transfusion and medicine.
– Equipment and drug preparation: the preparation of the appropriate anaesthesia equipment according to the method chosen. If a whole-body anesthesia is selected, it is necessary to ensure that the anesthesia functions well and that the various monitors function properly, including the monitoring of blood pressure, heart rate, blood oxygen saturation, pneumatic CO2 concentration, etc. If anaesthesia of the vertebrae is selected, anaesthesia of the vertebrae is prepared. In addition, emergency medications, such as adrenaline, atropine, ephedrine, etc., should be prepared to deal with possible emergencies during anaesthesia, such as severe hypotensive pressure and heart disorders.
(iv) Monitoring and management of anaesthesia
The continuous and close monitoring of vital signs such as blood pressure, heart rate, breathing, blood oxygen saturation, etc. of patients during anaesthesia is essential. Monitoring of the CO2 concentrations of the vents is also essential for the whole body of anesthesia. If the blood pressure is found to be too low, it may be necessary to increase the rate of the infusion of the fluid, to use an vascular condensation drug to increase the blood pressure; if the heart rate is too high or too slow, to analyse whether the effects of anaesthesia or changes in the patient’s own condition, such as the existence of uncontrolled bleeding, and to take appropriate measures, such as adjusting the depth of the anaesthesia and the use of anti-heart disorders.
2. In the case of persons with overall anaesthesia, an accurate determination of the depth of anaesthesia is key to the smooth operation and the safety of the patient. Anesthesiologists can make a preliminary determination of the depth of anaesthesia by observing clinical signs of the patient, such as eye reflexes, physical activity, response to surgical irritation, etc. At the same time, there are some advanced monitoring techniques, such as the Brain Double Frequency Index (BIS) monitoring, which more accurately reflect the anaesthesia of patients. The appropriate depth of anaesthesia ensures that the patient is free of pain during the operation and reduces adverse effects such as respiratory and circulatory inhibitions caused by anaesthesia.
3. Liquid management The volume of the infusion and the speed of the infusion are to be calculated accurately on the basis of the patient ‘ s haemorrhage, blood pressure, heart rate, etc. For a large number of bleeding patients, timely blood transfusions may be required to maintain an effective circulation. At the same time, attention should be paid to the choice of type of infusion and to avoiding excessive input of crystal fluids leading to tissue oedema, which affects the recovery of patients. During the infusion, the patient ‘ s respiratory and lung consultations are closely observed to prevent complications such as pulmonary oedema. II. Guidance for care after extrauterine pregnancy
(i) General care
1. Vital signs are followed by close observation of vital signs such as blood pressure, heart rate, breathing, body temperature, etc. of the patient. Measurements are generally required at intervals such as blood pressure, heart rate and breathing every 15 – 30 minutes until the patient ‘ s condition is stable. An increase in body temperature may indicate a risk of infection, while a decrease in blood pressure and an acceleration of heart rate may be an expression of abnormalities, such as haemorrhage, requiring timely reporting of treatment by a doctor.
2. Physical care
When a patient returns to the ward after the operation, he or she usually needs to sleep on the bed for six hours, especially for anaesthesia in the vertebrate, which prevents complications such as headaches. It can then be adapted to the patient ‘ s condition in half-beds, which facilitate the flow of seepages within the abdominal cavity to the pelvic cavity and reduce the swollen swollen formation of the abdomen, while also facilitating the breathing and abdominal perforation.
3. Cross-cutting care
Observe seepage of blood, seepage, and maintain clean drying of the cut dressing. In the case of edema, increased pain, abnormal secretions, etc. in the mouth, there may be signs of oral infection, which should be treated in a timely manner, e.g., replacement of dressing, use of antibiotics, etc. (ii) Pipeline care, if a tube is placed in the operation, it shall be properly fixed to prevent distortion, pressure and fall. To observe the colour, volume and nature of the flow fluid, normal flow fluids are generally diluent and the amount decreases. If there is a sudden increase in lead fluids and red colours, there may be signs of active haemorrhage; if the lead fluids are pussy and smelly, there may be infections. In order to accurately record the evolution of the fluid, the fluids are replaced on medical advice in a timely manner.
(iii) The need for a gradual recovery of the diet of the patient after the surgery. There is a general need for fasting before intestinal functions are restored. When a patient has an anal ventilation, a small amount of water can be started, if not ill, and a gradual transition to aqueous food, such as rice soup, powder, etc., and then to a half-eating food, such as rice congee, noodles, etc. The diet needs to be light, digestive, rich in proteins and vitamins, and to avoid the consumption of spicy, greasy, irritating foods to promote physical recovery.
(iv) Pain care. The patient may have different levels of pain after the operation and must be assessed and treated in the light of the pain. Light pain can be distracted by talking to patients and playing music with ease. If the pain is more evident, painkillers, such as oral painkillers or the use of analgesic pumps, may be given on medical advice. At the same time, the patient ‘ s response following the use of analgesics is to be observed, with adverse effects such as absence of nausea, vomiting and dizziness.
Out-of-court pregnancy is a major physical and psychological trauma for patients, who may experience anxiety, fear, depression, etc., especially for those with reproductive requirements, and fear the effects of the surgery on future births. The caregiver communicates more with the patient, learns about his or her psychological state, gives care and comfort. To explain to the patient the circumstances of the operation and the recovery process, the patient is encouraged to respond positively and, if necessary, a psychologist can be consulted for psychological counselling.
(vi) Activity guidance Where the patient ‘ s condition permits, he or she is encouraged to reverse his or her bed at the earliest possible time, to engage in quadrilateral activities, such as stretching his or her lower limb, which can facilitate blood circulation and prevent the formation of a deep vein of the lower limb. When the patient ‘ s physical strength is gradually restored, he or she may gradually increase his or her activity, such as sitting up, standing by the bed, walking at short distances, etc., but be careful not to overwork and be accompanied by a person to prevent the patient from falling.
(vii) Observation and care of complications
1. Haemorrhage. Closely observe if the patient is exposed to haemorrhages such as paleness, panic, reduced blood pressure and increased abdominal pain. If there are signs of haemorrhage, further surgery may be required to stop the bleeding if the doctor is notified in a timely manner for treatment.
2. Observe if the patient has symptoms of hemorrhaging, oscillating, pain, fluid abnormalities, etc. Maintenance of the environment of the wards, strict application of sterile practices, rational use of antibiotics and prevention and control of infection, in accordance with medical instructions.
3. The formation of a deep vein of the lower limb is due to the high condensation of the blood as a result of reduced post-operative activity of the patient, and is prone to the occurrence of a deep vein of the lower limb. Care should be taken to observe cases of swelling, pain and increased skin temperature. Early patient activity is encouraged, and anticondensed drugs can be used to prevent blood clot formation for high-risk patients.
In general, anaesthesia and post-operative care for extrauterine pregnancy is an important component in ensuring the success and successful recovery of patients. Medical personnel need to work closely together to provide comprehensive care for the physical and psychological state of the patient and quality medical care.
Extrauterine pregnancy
