Medical anesthesia for normal childbirth

1. When a woman in labor is admitted to the maternity ward and there are signs of fear, anxiety, uncertainty, mental stress or emotional arousal, tranquilizers are prescribed - trioxazine at a dose of 300-600 mg orally, or diazepam at a dose of 5-10 mg, or phenazepam 0.0005 g orally in combination with spasmolytin, which also has a sedative and antispasmodic effect. A single dose of spasmolytin is 100 mg orally.
2. In the presence of regular labor activity and dilation of the cervical os by 3-4 cm in women in labor with pronounced psychomotor agitation, scheme No. 1 is used, which includes the following components:
   • - aminazine - 25 mg (2.5% solution - 1 ml);
   • - pipolfen - 50 mg (2.5% solution - 2 ml);
   • - promedol - 20 mg (2% solution - 1 ml).

The indicated substances are administered intramuscularly in one syringe.

3. In women in labor, in the absence of deviations in the psychosomatic state, the presence of regular labor activity and the opening of the cervix by 3-4 cm, the following combinations of drugs are administered (scheme No. 2):
   • propazine - 25 mg (2.5% solution - 1 ml);
   • pipolfen - 50 mg (2.5% solution - 2 ml);
   • promedol - 20 ml (2% solution - 1 ml).

This combination of substances is also administered intramuscularly in one syringe.

If the analgesic effect from the administration of the indicated drugs is insufficient, these drugs can be administered again in half the dose at an interval of 2-3 hours. In the group of women in labor, who after administration according to scheme No. 1 or No. 2 have a pronounced sedative but insufficient analgesic effect, only one promedol can be administered at a dose of 20 mg, intramuscularly, at the same interval.

4. For a more pronounced and prolonged analgesic effect, as well as relaxation of the pelvic floor and perineal muscles, it is advisable after using scheme No. 1 or No. 2 at the end of the dilation period for multiparous women or at the beginning of the expulsion period for primiparous women, i.e. 30-45 minutes before the birth of the child, to administer intravenously to the woman in labor a 10% solution of mephedol - 1000 mg in a 5% glucose solution (500 mg). In this case, the mephedol solution is administered slowly over 1-1.5 minutes. Another centrally acting muscle relaxant can also be administered, which is similar in its pharmacological properties to mephedol, but does not depress breathing in women in labor. The combined use of neurotropic agents with analgesics and mephedol according to the method described above allows for achieving pronounced and longer pain relief during labor in the first and second stages of labor. In this case, a very significant circumstance is that it is possible to avoid the undesirable influence of anesthetics on the respiratory center of the fetus.

Pain relief during normal labor with neurotropic agents with analgesics and inhalation anesthetics from the group of halogen-containing

1. When a woman in labor is admitted to the maternity ward, tranquilizers are prescribed and then scheme No. 1 or No. 2.
2. If the analgesic effect is insufficient when using the above regimens, the latter can be combined with the use of inhalation anesthetics - trichloroethylene at a concentration of 0.5 vol %, fluorothane - 0.5 vol % or methoxyflurane - 0.4-0.8 vol %. Preliminary administration of neurotropic agents (tranquilizers, propazine, pipolfen), which cause a pronounced sedative effect, also helps to enhance the effect of inhalation anesthetics, due to which a significantly smaller amount of anesthetic is required for pronounced analgesia during labor.

Method of using trichloroethylene in combination with neurotropic agents and analgesics. 1-2 hours after the introduction according to scheme No. 1 or No. 2, when there is a pronounced sedative, but insufficient analgesic effect - trichloroethylene inhalations are used. In this case, initially, during the first 15-20 minutes, the concentration of trichloroethylene should be 0.7 vol.%, then its concentration is maintained within 0.3-0.5 vol.%. Trichloroethylene inhalations are carried out with the active participation of the woman in labor herself at the time of contraction. In this case, the woman in labor has the opportunity to be in contact with the doctor or midwife conducting the birth all the time. The duration of analgesia should not exceed 6 hours. The total amount of trichloroethylene consumed is on average 12-15 ml.

Method of using fluorothane in combination with neurotropic agents and analgesics. In women in labor with frequent and intense contractions accompanied by sharp pain after administration according to scheme No. 1 or No. 2 after 1 1/2 - 1 hour, it is more preferable to use fluorothane inhalations in a concentration of 0.3-0.5 vol. %, which, along with a pronounced analgesic effect, contribute to the normalization of labor and a smoother course of the period of opening and the period of expulsion. The duration of fluorothane inhalations should not exceed 3-4 hours.

Method of using methoxyflurane in combination with neurotropic agents and analgesics. After the introduction according to scheme No. 1 or No. 2 after 1-1.2 hours. In women in labor with pronounced psychomotor agitation, it is more advisable to use methoxyflurane (pentran). In this case, you can use a special evaporator "Analgizer" from the company "Abbott", which allows you to create an analgesic concentration of methoxyflurane - 0.4-0.8 vol % (maximum concentration of the anesthetic). The technique for performing autoanalgesia is as follows: the woman in labor tightly covers the mouth end of the "Analgizer" with her lips and takes deep breaths through it, exhaling through the nose. After 8-12 breaths, when the woman in labor gets used to the smell of the anesthetic, the dilution hole is closed with a finger. Women in labor easily adapt to the device and regulate the conduct of analgesia themselves following the relevant instructions. Inhalations of pentrane can be carried out using the domestic device "Trilan", into which 15 ml of pentrane is poured (for 2 hours of pentrane inhalations during labor). The use of the "Trilan" device facilitates the passage of the gas flow through the device's evaporator only during inhalation, which ensures a more economical use of the anesthetic compared to "Analgizer" and, thanks to good sealing, pain relief is more effective. With the onset of the second stage of labor, the use of inhalation anesthetics may not be stopped. The anesthetic does not have a negative effect on the contractile activity of the uterus, the condition of the fetus and the newborn.

Method of pain relief during normal labor with neurotropic agents with analgesics and non-inhalational steroid drugs. Due to the fact that non-inhalational steroid drugs (viadril, sodium oxybutyrate) do not have a sufficient analgesic effect in doses used in obstetric practice, it is advisable to use them against the background of neurotropic and analgesic agents for the purpose of pain relief during labor.

After the introduction of scheme No. 1 or No. 2, after 2 hours, if the analgesic effect is insufficient, the latter are combined with intravenous administration of 1000 mg of Viadryl. In this case, the Viadryl solution is prepared immediately before use - 500 mg of dry substance is dissolved in 10 ml of 0.25% - 0.5% novocaine solution (one bottle contains 500 mg of dry substance of Viadryl). Viadryl is administered quickly and subsequently, to prevent phlebitis, it is advisable to administer another 10 ml of novocaine (0.25% - 0.5% solution). Sleep occurs in the first 5-10 minutes and lasts on average about 1-2 hours. For identical indications, sodium oxybutyrate can be administered in an amount of 20 ml of a 20% solution. The effect of the latter is basically similar to the effect of Viadryl. The analgesic effect occurs within the first 10-15 minutes and lasts for about 1 hour 30 minutes.

Pain relief during normal labor: ataralgesia (dilidolor + seduxen) in combination with halidor. In the presence of regular labor activity, cervical os dilation of 3-4 cm and severe pain, women in labor are given 6 ml of a mixture containing 2 ml (15 mg) of dipidolor, 2 ml (10 mg) of seduxen and 2 ml (50 mg) of halidor in one syringe, intramuscularly.

When choosing different doses of seduxen and dipidolor, one should proceed from the psychosomatic state of the woman in labor and the severity of pain. In case of significant psychomotor agitation, fear, anxiety, the dose of seduxen should be increased to 15-20 mg, and if painful contractions prevail, but without pronounced agitation, and especially if the woman in labor is depressed, the dose of seduxen can be reduced to 5 mg. The dose of halidore is chosen based on the height and weight of the woman in labor and is re-administered after 3-4 hours.

Repeated administration of seduxen and dipidolor with this method of pain relief is usually not required. However, if labor has not ended in the next 4 hours, the administration of the drugs can be repeated in half the dose. For a faster and more pronounced effect of ataralgesia, the drugs can be administered intravenously slowly in the same doses mixed with 15 ml of 0.9% sodium chloride solution or 5-40% glucose solution. The last administration of dipidolor should be no later than 1 hour before the expected start of the expulsion period.

Clinical studies show that ataralgesia during normal labor, using dipidolor, creates a state of mental calm, suppresses the feeling of fear and anxiety, has an analgesic effect of sufficient strength and duration, and is accompanied by stabilization of hemodynamic parameters. When using ataralgesia, women in labor doze between contractions, but are conscious and easily interact with the service personnel.

No harmful effects of ataralgesic drugs on the course of labor and the newborn have been identified.

Ataralgesia has a beneficial effect on a number of indicators during labor: the overall duration of labor is shortened by 5 hours in primiparous women and by 3 hours in multiparous women, the rate of dilation of the cervix increases, the frequency of early rupture of amniotic fluid and blood loss during labor decreases.

Neuroleptanalgesia (droperidol + fentanyl) in combination with antispasmodics. In the presence of regular labor activity and the opening of the uterine os by at least 3-4 cm, the following mixture is administered intramuscularly in one syringe to women in labor: droperidol - 5-10 mg (2-4 ml) and fentanyl - 0.1-0.2 mg (2-4 ml). The doses of droperidol and fentanyl should be selected (as well as the doses of dipidolor and seduxen), based on the severity of pain and psychomotor agitation.

Repeated administration of droperidol should be applied after 2-3 hours and stopped no later than 1 hour before the start of the expulsion period. Fentanyl should be repeated every 1-2 hours. Considering the possibility of the depressing effect of fentanyl on the fetal respiratory center, the last administration of the drug should be done 1 hour before the expected birth. Simultaneously with the administration of droperidol and fentanyl, halidor is prescribed in a dose of 50-100 mg. The same dose is repeated after 3-4 hours. The average single dose of droperidol was 0.1-0.15 mg per 1 kg of the mother's body weight, and fentanyl - 0.001-0.003 mg / kg. Pain relief of normal labor with benzodiazepine derivatives (diazepam, seduxen) in combination with the analgesic promedol.

For the same indications as for ataralgesia, in the presence of regular labor activity and dilation of the uterine os by 3-4 cm, 10 mg (2 ml) of seduxen diluted in 5 ml of isotonic sodium chloride solution is administered intravenously or intramuscularly. Seduxen should be administered slowly: 1 ml of the ampoule preparation per 1 min. With faster administration, the woman in labor may sometimes experience mild dizziness, which quickly passes, and diplopia.

One hour after the administration of seduxen, 20 or 40 mg of promedol solution is administered intramuscularly. The duration of analgesia with the combined use of seduxen and promedol lasts 2-3 hours. In this case, seduxen cannot be administered either intravenously or intramuscularly in combination with other substances in one syringe. The total dose of seduxen during labor should not exceed 40 mg intravenously or intramuscularly. This combination of substances does not have a negative effect on the body of the mother in labor, the contractile activity of the uterus, and the condition of the fetus and newborn.

Method of using Lexir. Pain relief during labor with Lexir should be started when the cervix is 4-5 cm dilated. The drug can be administered intramuscularly or (if a quick effect is needed) intravenously at a dose of 30-45 mg. Depending on the psychoemotional state of the woman in labor, it can be combined with seduxen or droperidol. In all cases, it should be administered against the background of antispasmodic drugs (preferably halidorin at a dose of 50-100 mg). Repeated injections of Lexir should be given after 1-1 1/2 hours with a total dose of no more than 120 mg. The last injection is given no later than 1-1 1/2 hours before the end of labor. When using Lexir, the psychomotor reaction to contractions decreases, and tired women in labor doze off during the pauses between contractions. Lexir does not have a negative effect on labor and the fetus with this method of pain relief. On the contrary, the duration of the opening period is somewhat shortened. However, if the last injection of the drug coincides with the beginning of the expulsion period, this negatively affects the effectiveness of pushing due to the weakening of the reflex from the perineum.

Method of using baralgin. In women in labor, if there are sharply painful contractions at the very beginning of the dilation period, it is recommended to use spasmoanalgesics - baralgin, 5 ml of standard solution.

When using baralgin, along with the spasmolytic effect, a pronounced central analgesic effect is also noted. At the same time, the total duration of labor under the conditions of using baralgin does not exceed 11 hours for primiparous and 9 hours for multiparous women. A detailed analysis of the course of the dilation period showed that the use of baralgin leads to a shortening of the dilation period by 2 times for both primiparous and multiparous women.

The use of baralgin in women giving birth for the second time has a number of features that doctors need to take into account in their practical activities. Thus, the use of baralgin in women giving birth for the second time with the opening of the uterine orifice by 5-6 cm leads to an extension of labor by 1 hour, and with the opening of the uterine orifice by 7 cm or more, a pronounced spasmolytic effect is again noted.

Abdominal decompression

In order to relieve pain during childbirth, some authors suggest influencing the area of the Zakharyin-Ged skin zones with the following physical factors: cold, heat, local vacuum.

In the 1960s, a method of abdominal decompression was proposed abroad for the purpose of pain relief and acceleration of labor, which in the first stage of labor leads to a decrease or complete cessation of pain in 75-86% of women in labor. The decompression technique is carried out as follows: having slightly stretched the edges, the chamber is placed on the abdomen of the woman in labor. Then, air is pumped out of the space between the walls of the chamber and the surface of the abdomen using a compressor during each contraction, reducing the pressure in the chamber by 50 mm Hg and maintaining it between contractions at a level of 20 mm Hg. To pump out air, a surgical suction can be used, which creates a vacuum in the chamber of up to 50 mm Hg within 6-8 seconds. The maximum duration of decompression with short breaks was 3 hours. A good pain-relieving effect is observed in 51% of women in labor; with adequate behavior and reactions to pain, the analgesic effect reaches 75%, while in women in labor with pronounced psychomotor agitation, the presence of a sense of fear and others - only 25%. Contractile activity of the uterus in most women in labor increases. The method of abdominal decompression does not have a negative effect on the intrauterine fetus, newborns and their development in the following days of life.

Electroanalgesia

Since 1968, academicians L. S. Persianinov and E. M. Kastrubin have developed a method of electroanalgesia in labor with frontal-occipital application of electrodes. In this case, the therapeutic effect of electroanalgesia is achieved with a stepwise increase in current strength during the session, depending on the threshold sensations of the woman (on average, up to 1 mA). The duration of the session is 1-2 hours. After 40-60 minutes of exposure to pulsed currents, a drowsy state is observed between contractions, and during a contraction, a decrease in the pain response. In the presence of restless behavior with a predominance of neurosis, the authors recommend starting an electroanalgesia session after the preliminary administration of pipolfen, diphenhydramine or promedol.

Ketamine pain relief during labor

1. Intramuscular injection technique. Ketamine is recommended to be used in doses of 3-6 mg/kg of body weight, taking into account individual sensitivity to it. The drug is administered starting with 3 mg/kg, but one should not strive to obtain narcotic sleep: the woman in labor should have complete anesthesia with inhibition, which does not interfere, however, with contact with her. The next injection is performed after 25-30 minutes, and if the anesthesia is insufficient, the dose is increased by 1 mg/kg.

The amount of ketamine should not exceed 6 mg/kg of body weight; if satisfactory pain relief is not achieved in this case, it is recommended to switch to other methods of anesthesia. However, such situations are extremely rare, their frequency does not exceed 0.2%. The duration of anesthesia is selected individually, based on the specific obstetric situation, the use of ketamine is subject to the general principles of drug pain relief in labor. The last administration of ketamine should be done at least 1 hour before the beginning of the second stage of labor.

Additionally, it is always recommended to prescribe 5-10 mg of seduxen or 2.5-5.0 mg of droperidol intravenously or intramuscularly to relieve the “awakening reaction”.

2. Intravenous administration technique. Intravenous administration of ketamine as a method of long-term pain relief during labor is more preferable due to its high controllability. After the administration of 5-10 mg of seduxen, a drip infusion of ketamine diluted with any plasma-substituting solution is started at an infusion rate of 0.2-0.3 mg/(kg - min). Complete anesthesia usually occurs in 4-8 minutes. By smoothly regulating the flow of the anesthetic (preferably using a perfusor), the woman in labor maintains consciousness with a complete absence of pain sensitivity. As a rule, this can be done at a drug flow rate of 0.05-0.15 mg/(kg x min). If there is no possibility of constant dynamic monitoring of the woman in labor, it is recommended to use minimal amounts of ketamine at an infusion rate of 0.03-0.05 mg/(kg x min). This allows achieving significant anesthesia in most cases and simultaneously anesthetizing several women in labor. The intravenous method of administering the drug allows for easy control of the level of anesthesia and the narcotic inhibition of the woman in labor. Stopping the infusion immediately before the second stage of labor allows the woman in labor to actively participate in it.

The onset of anesthesia occurs without signs of agitation, and characteristic hemodynamic changes usually disappear within 5-10 minutes from the start of ketamine administration. No negative effects on uterine contractility, fetal and neonatal condition have been noted. Pathological blood loss or subsequent hypotonic bleeding are observed less frequently than usual.

However, sometimes the ease of ketamine anesthesia is combined with a relatively long postoperative depression of consciousness, requiring active monitoring of the patient, especially when ketamine is used as an anesthetic aid in cesarean section, minor obstetric and gynecological operations (manual examination of the uterine cavity, suturing of perineal ruptures, etc.). Based on this, an attempt at drug regulation of ketamine depression using direct anti-narcotics should be considered justified. When using the gutimine derivative amtizole, its distinct awakening effect was noted with the introduction of large doses of sodium oxybutyrate. In addition, the inclusion of seduxen and droperidol in direct premedication did not solve the problem of postoperative hallucinosis: the often occurring motor-motor agitation creates difficulties in caring for patients.

Amtizol in a dose of 5-7 mg/kg of body weight is used as a 1.5% solution immediately after the woman is delivered from the operating room. The entire dose of the drug was administered intravenously at one time or in two doses with an interval of 1 hour (these were mainly women who underwent emergency abdominal cesarean section and during labor pain relief with ketamine), and amtizol was also used to terminate the anesthetic effect of ketamine after short-term operations. Psychological tests were used as a criterion for the action of amtizol, which allow us to determine the rate of restoration of concentration of attention and the speed of reaction to a moving object. The following tests were used: reaction to a moving object, the ratio of the speed of the delayed reaction to the advance reactions, the critical frequency of flickering in both eyes, separately in the right and left, the total separate average frequency of flickering and the difference reflecting the dissimilarity of nervous processes in the left and right hemispheres of the brain, which is most often positive for the right. The tests were repeated every 10-15 minutes until the initial reactions before the introduction of ketamine were restored. It was found that spontaneous resolution of post-anesthetic depression after the introduction of 100-120 mg of ketamine occurs only in the 75th - 80th minute. With amtizol, complete restoration of the speed of concentration of attention and the speed of reaction to a moving object occurs 4-5 times faster. Moreover, the reaction to a moving object with the introduction of amtizol even accelerates. At the same time, with spontaneous resolution of depression of consciousness after the introduction of 120 mg of ketamine, even after 80 minutes, it is 1.5 times slower than the initial level. Under the same circumstances, the ratio of delayed reactions to advanced ones is significantly less than before ketamine anesthesia. Thus, the gutimin derivative - amtizol has a distinct positive effect on the processes of consciousness recovery and significantly reduces hallucinogenic manifestations in depression of consciousness after prolonged anesthesia with ketamine. The effect of amtizol against the background of a stable state of vital functions is not combined with stimulation or depression of respiration and hemodynamics. Its antinarcotic effect, apparently, has a predominantly central genesis, since amtizol is a drug of central non-specific action. The cessation of the anesthetic effect of a single dose of ketamine of 100-200 mg after the introduction of amtizol at a dose of 3 mg / kg of body weight allows the use of ketamine in short-term operations (no more than 10 minutes).

Pain relief during complicated labor in women with toxicosis in the second half of pregnancy

In women in labor with late toxicosis, a combination of psychoprophylactic preparation of pregnant women for childbirth and drug pain relief during labor is necessary, since the lack of pain relief in them, as is known, can lead to a deterioration in the condition of the mother and fetus.

Methods of pain relief during childbirth. Edema of pregnant women.

In case of regular labor and dilation of the cervix by 2-4 cm, the following substances are administered intramuscularly in one syringe: propazine at a dose of 25 mg; diphenhydramine - 40 mg or pipolfen - 50 mg; promedol - 20 mg; dibazol (in a separate syringe) - 40 mg.

For women in labor with the hypertensive form of late toxicosis - diprazine in a dose of 50 mg or pipolfen - 50 mg; propazine - 25 mg; promedol - 20 mg; pentamine - 25-50 mg or droperidol 3-4 ml (7.5-10 mg); fentanyl - 2-4 ml (0.1-0.2 mg). At the same time, women in labor with edema of pregnancy are prescribed an antispasmodic - ganglerone - 30 mg intramuscularly, and for hypertensive forms of late toxicosis - spasmolitin in a dose of 100 mg.

To enhance analgesia or independently use autoanalgesia for women in labor with edema of pregnancy - trichlorethylene in a concentration of 0.5 vol. %, methoxyflurane - 0.4-0.8 vol. %, ether - 1 vol. %, nitrous oxide with oxygen in a ratio of 3: 1, and for women in labor with hypertensive forms of late toxicosis - fluorothane in a concentration of 1 vol. %. In addition, upon admission to the maternity ward, women in labor with a hypertensive form of late toxicosis are prescribed tranquilizers - nozepam at 0.01 g (1 tablet) or diazepam - 15 mg orally in combination with spasmolitin, which has a central sedative and antispasmodic effect.

In case of grade III nephropathy and preeclampsia. Along with the ongoing therapy for late toxicosis, upon admission of the woman in labor to the maternity ward, diazepam is administered intramuscularly at a dose of 10 mg or droperidol also at a dose of 10 mg.

In the presence of painful contractions, a combination of propazin, pipolfen, promedol, and pentamine is administered intramuscularly in the doses indicated above. In the presence of high blood pressure, pentamine can be administered again at intervals of 1-2 hours in a dose of 50 mg, intramuscularly under the control of blood pressure up to 3-4 times during labor.

Pain relief during childbirth does not exclude the use of specific methods of treating late toxicosis.

Pain relief during childbirth in some diseases of the cardiovascular system

In case of hypertension, women in labor are prescribed tranquilizers upon admission - nozepam 0.01-0.02 g orally and antispasmodics - spasmolitin - 100 mg orally and 2 ml of a 2% dibazol solution intramuscularly.

In the presence of regular labor activity and dilation of the cervix by 2-4 cm, the following combination of drugs is administered: aminazine 25 mg, promedol - 20 mg, pentamine - 25 mg, gangleron - 30 mg intramuscularly in one syringe. To enhance analgesia, inhalation anesthetics are used - trichloroethylene in a concentration of 0.5-0.7 vol.% and fluorothane - 0.5-1.0 vol.%.

Women in labor with hypotension

Upon admission, tranquilizers are prescribed - nozepam 0.01 g (1 tablet) orally.

To relieve pain during labor, the following combination of substances is administered: spasmolitin orally at a dose of 100 mg; promedol intramuscularly - 20 mg; diphenhydramine - 30 mg; diprazine (pipolfen) - 25 mg.

To enhance analgesia, nitrous oxide and oxygen are used in a 2:1 ratio.

Microperfusion of clonidine during labor

The problem of treating arterial hypertension during labor remains relevant in practical obstetrics. Promising agents should be those that promote activation of certain central adrenergic structures in small doses and significantly affect both the circulatory system and the regulation of pain sensitivity. One of such drugs is clonidine, which has a pronounced hypotensive effect and a distinct analgesic effect in minimal therapeutic doses. The use of clonidine is to a certain extent complicated by the difficulties of selecting the optimal dose, as well as the possibility of developing diverse hemodynamic reactions, which is especially important in the treatment of pregnant women and women in labor with hypertensive forms of toxicosis, who have significant disturbances in microcirculation, organ and systemic circulation.

The obtained clinical data confirm that clonidine is an effective hypotensive agent and has a distinct analgesic effect. If the severity of the hypotensive effect is directly proportional to the doses of the drug used, then the analgesic effect is the same over a wide range of doses.

The use of clonidine perfusion at a rate of 0.0010-0.0013 mg/(kg x h) during labor results in a decrease in arterial pressure by an average of 15-20 mm Hg due to a slight decrease in systemic arterial tone with other indices of the central hemodynamics of the woman in labor remaining unchanged. No negative effect on uterine contractility or the condition of the fetus was noted. When using clonidine as intravenous perfusion at a rate of 0.0010-0.0013 mg/(kg x h), satisfactory analgesia and a moderate hypotensive effect are achieved.

Compensated heart defects

When the woman in labor is admitted to the maternity ward, tranquilizers are prescribed - nozepam - 0.01 g (1 tablet) or phenazepam - 0.0005 g (1 tablet) orally and appropriate cardiac therapy is administered as needed. The following combination of substances is administered intramuscularly in one syringe: pilolfene - 50 mg, promedol - 20 mg, gangleron - 30 mg, propazin - 25 mg.

Decompensated heart defects and myocardial dystrophy

Tranquilizers and cardiac therapy are prescribed. The following combination of drugs is administered intramuscularly in one syringe: pipolfen at a dose of 50 mg, promedol - 20 mg, gangleron - 30 mg. To enhance analgesia or independently, autoanalgesia with nitrous oxide + oxygen in a ratio of 3:1 or 2:1 is used.

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