Endotracheal Anesthesia Research Articles

Effect of Different Oxygen Concentrations Used During Multicomponent Endotracheal Anesthesia on the Structural and Functional Parameters of Red Blood Cells

Objective: to study the effect of different concentrations of oxygen on structural and functional parameters of red blood cells during balanced multicomponent sevoflurane-based endotracheal anesthesia. Subjects and methods. The prospective, randomized trial enrolled 20 persons (aged 52.7±16.2 years) who underwent the same surgical procedure. The patients were divided into 2 groups, which differed inintraoperatively used oxygen concentration in the inspired mixture,50% FiO2 (group 1) and 21% FiO2 (Group 2). A morphological difractometric analysis of patients’ red blood cells was performed preoperatively, intraoperatively, and after anesthesia. Results. In Group 1, red blood cells demonstrated statistically significant trend towards macrocytosis (82.4±23.3 fl before general anesthesia versus 85.1±20.6 fl after anesthesia; р=0.02); in group 2, there were no statistically significant changes in red blood cell volumes. Lateral light scattering was ignificantly decreased after anesthesia in Group 1 (146.2±17.7 U versus 162.9±23.0 U prior to anesthesia (р<0.005) and 156.4±16.3 U during the surgery (р<0.05)). The coefficient of variation in half-height of lateral light scattering of red blood cells was also significantly increased at the final stage of observation in Group 1 (26.3±3.1 U versus 22.1±5.0 U during surgery, рKey words: red blood cells, homeostasis, general anesthesia, hyperoxia, morphological difractometry.

Acute Pulmonary Vasodilator Testing With Inhaled Treprostinil in Children With Pulmonary Arterial Hypertension

Acute pulmonary vasodilator testing (AVT) is essential to determining the initial therapy for children with pulmonary arterial hypertension (PAH). This study aimed to report the initial experience with inhaled treprostinil used for AVT in children with PAH and to evaluate the hemodynamic change after inhaled treprostinil compared with inhaled nitric oxide. This prospective cohort study was designed for 13 children who underwent AVT with inhaled treprostinil or oxygen plus inhaled nitric oxide (iNO) during catheterization. Inhaled treprostinil was delivered during cardiac catheterization by adapting the Optineb ultrasonic nebulizer via either a flow-inflating bag or the manual mode of the anesthesia system. The median age of the patients was 10 years (range 4-17 years). The etiologies of PAH included idiopathic PAH and associated PAH. All the patients tolerated inhaled treprostinil without marked clinical worsening and received six or nine breaths (36 or 54 μg) of treprostinil. The median of the total treprostinil doses was 1.53 μg/kg (range 0.71-2.89 μg/kg). Inhaled treprostinil was administrated via an endotracheal tube (n = 8), anesthesia mask (n = 3), or laryngeal mask airway (n = 2). Inhaled nitric oxide (iNO) and inhaled treprostinil significantly decreased the mean pulmonary artery pressure and the pulmonary vascular resistance index compared with baseline. Three adverse events were reported after inhaled treprostinil, including cough and mild to moderate hypotension with higher doses. All adverse events resolved without any intervention. This study report is the first to describe the use of inhaled treprostinil for AVT in children with PAH. In this small pediatric cohort, inhaled treprostinil was effectively delivered and well tolerated and may be useful for AVT.

The development of chemical narcotic and related anesthetic techniques in modern times

Before the 19(th) century, ether and nitrous oxide were synthesized. However, they were just used as a kind of enjoyable things at night gatherings for their hypnotic and analgesic effect. In the 19(th) century, ether and nitrous oxide came into use in clinical anesthesia. Thereafter, more and more chemical narcotics were synthesized and applied to clinical anesthesia. In 1872, chloroform was injected into man's vein for anesthesia. In the 20(th) century, along with many kinds of barbiturates being synthesized, intravenous anesthesia got much development and application. At the same time, related techniques of anesthesia also improved. In the early 19(th) century, open inhalation anesthesia was often used. In 1900, there came a new anesthesia method by blowing into the windpipe through the cut of throat. Later on, the technique of endotracheal anesthesia and artificial respiration anesthesia (1908), the anesthetic instrument of endotracheal intubation and laryngeal mask and laryngoscope were invented. In the mid 19(th) century, the appearance of injection syringe and cocaine made local anesthesia possible. In 1880, local anesthesia also became successful. Thereafter, a variety of local anesthetic drugs were synthesized and applied, companying with various techniques of local anesthesia such as subarachnoid anesthesia (1900), sacral anesthesia (1901), epidural block (1903), plexus block (1902) and so on. In order to control the depth of anesthesia and respiration effectively, people attempted a lot so that anesthesia machine (1910), improved endotracheal anesthesia (1921), cryogenic technique (1902), controlled hypotension (1940s) and artificial hibernation (1950) came into being.

Transoral Endoscopic Resection of Esophageal Liposarcoma

A 63-year-old man presented with a 1-month history of dysphagia. Endoscopy showed the patient had a mass in the cervical esophagus. Multiple biopsy specimens were taken, which were inconclusive for a diagnosis. A positron-emission tomography scan showed a hypermetabolic lesion. A transoral endoscopic approach was used to resect the tumor. Final histologic examination revealed a completely resected low-grade liposarcoma.

Effect of systemic lidocaine infusion on train-of-four ratios during recovery from general anesthesia

IntroductionIn spite of introduction of intermediate-acting neuromuscular blocking drugs (NMBDs), incidence of postoperative residual muscle weakness is still high. The aim of this trial is to study the effect of systemic lidocaine infusion on intraoperative consumption of rocuronium and TOF ratios at extubation and on arrival to postanesthesia care unit (PACU).MethodsForty-six ASA I–III patients aged 16–60 yr were randomly allocated into two groups: lidocaine (L) group (n = 23) and control (C) group (n = 23). After induction of standard endotracheal general anesthesia with fentanyl, propofol and rocuronium, patients of group L were given i.v. lidocaine bolus (1.5 mg kg−1) followed by continuous infusion (1.5 mg kg−1 h−1) till time of endotracheal extubation while patients in group C were given equal volumes of normal saline. Rocuronium was titrated based on clinical signs. On conclusion of surgery, neostigmine was given to reverse the effects of rocuronium if TOF count was two or more. Immediately before extubation, TOF ratio was measured and recorded and considered the primary outcome.ResultsThere were no significant differences between the two study groups regarding intraoperative fentanyl doses or core temperature at the end of surgery. End-tidal sevoflurane concentrations were significantly lower in group L than in group P (P < 0.01). The dose of rocuronium was significantly less in group L than in group C (P = 0.001). Train-of four ratios were significantly higher in group L than in group C either before extubation (P < 0.001) or on arrival to PACU (P = 0.001).ConclusionThe current study shows that intraoperative use of i.v. lidocaine infusion in generally anesthetized patients can result in higher TOF ratios at time of extubation and on arrival to PACU when rocuronium was given based on clinical signs.

CONTROL OF LABORATORY PARAMETERS LEVEL AS A COMPONENT OF ANESTHESIA MONITORING IN PATIENTS UNDERGOING ABDOMINAL SURGERY

The changes in the parameters of hemodynamic, electroencephalographic entropy, levels of glucose, lactate and cortisol were studied in 85 patients, operated on organs of abdominal cavity in the conditions of effective anesthesiological protection on the basis of multicomponent endotracheal anesthesia with application of inhalation anesthetics and total intravenous anesthesia. It was determined that the control level of glucose, cortisol and lactate in blood serum was an informative biochemical indicator of anesthesia adequacy during abdominal operations and can be successfully employed as a corresponding part of the intraoperational monitoring.

Application of extubating with negative pressure suction in endotracheal tube extubation

Objective To investigate the feasibility,safety and efficacy of tracheal extubation with directly connected negative pressure suction. Methods 86 patients with Ⅰ or Ⅱ degree of ASA,aged 18～65 years old,without history of respiratory disease,difficult airway and ventilation problems were involved in this study.All patients undergoing endotracheal general anesthesia were randomly divided into group A and B with 43 cases in each group.Group A used negative pressure directly connected to external side of the endotracheal tube before extubation.Group B used suction tube putting into the endotracheal tube before extubation.MAP,HR,ECG,SpO2,the condition of cough and expectoration and complicatons after extubation were recorded. Results In group A the MAP,HR slightly increased,SpO2 slightly decreased,ECG showed no significant change,but the differences were not significant.In group B,MAP,HR,SpO2 showed significant difference compared with those before extubation and the corresponding period of group A. Conclusions The method that connecting negative pressure suction with endotracheal tube can effectively reduce the cardiovascular response during extubation,It also can avoid hypoxia,reduce the tracheobronchial injury and pulmonary complications.It's a practical good method in tracheal extubation. Key words: Negative pressure suction; Endotracheal suction; Extubation of endotrachel tube; Method; Complication

Novel Use of Lidocaine/NaHCO3 Mixture Within Endotracheal Tube Cuff

In outpatient clinic or operating room settings, anesthesia is an important part of modern oral and maxillofacial surgery. Measures to decrease bucking, coughing, and hypertension during general endotracheal anesthesia (GETA) emergence attempt to make emergence “smoother.” A smooth emergence and a decreased incidence of postoperative sore throat are very desirable after orbital fracture, complex facial trauma repair and orthognathic surgery. Bucking and hypertension during emergence from GETA after fracture repair with orbital content manipulation may cause increased hemorrhage and increased intraocular pressure that could negatively affect the patient's postoperative course.

Ultrasound detection of guidewires in‐plane during pediatric central venous catheterization

To assess the usefulness of longitudinal ultrasound images of guidewires for pediatric central venous catheter (CVC) placement. To avoid arterial placement of a CVC, it is important to ensure that the guidewires are in the internal jugular vein (IJV) before inserting the dilators. Ultrasound confirmation of the guidewire position may eliminate accidental arterial dilation during CVC cannulation. Fifty pediatric patients undergoing general endotracheal anesthesia for cardiovascular surgery were enrolled. The mean ± sd value for age was 14.8 ± 16.8 months; height, 69.1 ± 14.6 cm; and weight, 7.1 ± 3.2 kg. Longitudinal ultrasound images of guidewires in or around the right IJV during pediatric CVC placement were acquired using an L10-5 MHz probe (TiTAN(®); SonoSite Co., Tokyo, Japan), with the neck of the patient fully extended and the head turned 15-30 degree to the left. In 42 (84%) patients, guidewires were visible in the lumen of the IJV. However, in 8 (16%) patients, guidewires were not visible. Longitudinal imaging of guidewires was achieved with high probability (100%) in children in whom the distance from the clavicle to the angle of the mandible was more than 59 mm, in whom the distance from the clavicle to the puncture site was more than 30 mm, or in children taller than 65 cm. All cannulations were confirmed to be CVCs by chest radiography. To confirm the insertion of dilators into veins in children, we recommend that longitudinal images of the guidewires should be initially acquired.

The temporary effect of short-term endotracheal intubation on vocal function

The objective of the study was to assess and perceive the vocal and pharyngeal symptoms and acoustic changes of voice after short-term endotracheal intubation and to evaluate the relation between these changes and the endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. A total of 108 patients were evaluated preoperatively, 1-2 and 24 h after extubation. The vocal and pharyngeal symptoms, voice acoustic characteristics and maximum phonation time (MPT) were evaluated to find the relationship with endotracheal tube parameters, number of intubation attempts, duration of anaesthesia, experience of anaesthesiologist. All vocal and pharyngeal symptoms increased significantly at 24 h and remained significantly increased at 24 h after general anaesthesia. The vocal acoustic parameters changed significantly at 1-2 h: decrease of MPT and increase relative average perturbation were recorded. The day after the short-term intubation: only noise to harmony ratio and habitual pitch remains significantly changed. The most important endotracheal tube parameters that affect significantly (P value <0.05) the vocal function were the size of tube, cuff volume and number of intubation attempts. In relation to the anaesthesia, the changes of the acoustic parameters did not associate significantly with the anaesthesia-related parameters. No statistically significant relationship between experience of an anaesthesiologist and changes of the voice after anaesthesia was detected. Though being short-term, endotracheal anaesthesia is an invasive procedure, and its temporary influence on vocal function is important.

Dialysis Access Flow Phenomenon Demonstrated via an Internal Jugular Central Venous Catheter Uniquely Positioned within a Superior Vena Cava Stenosis

Dialysis Access Flow Phenomenon Demonstrated <i>via</i> an Internal Jugular Central Venous Catheter Uniquely Positioned within a Superior Vena Cava Stenosis

Laryngopharyngeal complaints following short-term endotracheal intubation: peculiarities of males and females

Background. Laryngopharyngeal complaints are classified as minor post-intubation complications. They cause great discomfort, have some influence on the quality of life and can limit patient’s casual activity. The extent of complaints ranges from 12 to 65%. Undesirable complications can be avoided by ascertaining factors that are able to provoke or decrease laryngopharyngeal symptoms after endotracheal intubation. In this study, we assessed predominant laryngopharyngeal symptoms following a short-term endotracheal intubation and their peculiarities subject to gender, and we estimated the most important influencing factors. Materials and methods. 218 patients were examined before endotracheal anesthesia, 1–2 and 24 hours after extubation. The following laryngopharyngeal complaints were recorded: hoarseness, vocal fatigue, globus pharyngeus, throat pain and throat clearing. These factors were also assessed in relation to endotracheal intubation parameters: endotracheal tube size, cuff volume and pressure, number of intubation attempts, length of anesthesia, experience of anesthesiologist and additional parameters: smoking, allergy, GERD symptoms, laryngitis and singing skills subject to gender. Results. All laryngopharyngeal symptoms increased significantly in 2 hours after extubation and remained increased after 24 hours in both male and female groups. In 1–2 hours after extubation, females complained of throat pain more than males (61.3 vs. 42.9%; p = 0,014). The following significant relations were found 1–2 hours after extubation: between throat pain and length of anesthesia, globus pharyngeus and tube size and cuff volume in the male group; between globus pharyngeus, vocal fatigue and smoking, throat clearing and cuff volume in the female group. After 24 hours, the relation was noticed between vocal fatigue and cuff volume and number of intubation attempts, globus pharyngeus and length of anesthesia, between hoarseness and number of intubation attempts and between throat pain and singing skills in the male group. Some relation between throat clearing and cuff volume remained for 24 hours after extubation, smoking had influence on hoarseness and vocal fatigue in the female group. Conclusions. Laryngopharyngeal symptoms remain an important cause of discomfort for 24 hours after extubation. Females complain of laryngeal and pharyngeal symptoms more than males and throat pain following extubation is also more frequent in females. The most important parameters of short-term endotracheal intubation that influence laryngopharyngeal complaints are as follows: cuff volume, length of anesthesia and number of intubation attempts that affect males more than females. Smoking affects females more, though singing skills are more significant in the male group.

Superficial temporal artery–middle cerebral artery bypass using local anesthesia and a sedative without endotracheal general anesthesia

Superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses have continually evolved, and new strategies have been advocated for reducing anesthetic or surgical morbidity and mortality. Further simplifying, and decreasing the invasiveness of, STA-MCA bypass by performing this operation without endotracheal general anesthesia was believed to be feasible in certain subsets of patients. The authors performed STA-MCA bypass using local anesthesia with a sedative in 10 patients with hemodynamically compromised occlusive cerebrovascular disease, as well as multiple comorbidities, between February 2010 and September 2011. The technique is based on the preoperative identification of the point at which the donor and recipient vessels are in closest proximity. Preoperative use of CT angiography allowed the authors to identify the target point precisely and use a minimally invasive procedure. All patients received dexmedetomidine as the sole sedative agent, together with scalp-blocking local anesthesia, with an unsecured airway. Successful STA-MCA bypass surgeries were achieved via a preselected minimally invasive approach in all cases. There was good hemodynamic stability throughout surgery. No airway or ventilation complications occurred, and no patients were converted to general anesthesia. Subjectively, patients tolerated the technique well with a high rate of satisfaction. There were no perioperative morbidities or deaths. Postoperative MR angiography confirmed a patent bypass in all patients. All patients remained symptom free and returned to normal daily life following the operation. This initial experience confirms the feasibility of performing STA-MCA bypass without endotracheal general anesthesia. This novel technique produced a high degree of patient satisfaction.

Does neuromuscular blockade affect the assessment of pelvic organ prolapse?

The purpose of this study was to determine if anesthesia with neuromuscular blockade alters the Pelvic Organ Prolapse Quantification (POP-Q) examination. A prospective, multi-center trial was conducted of women undergoing pelvic surgery. A POP-Q examination performed pre-operatively was compared with an examination performed intra-operatively under neuromuscular blockade. For the latter examination, an Allis clamp was used to apply gentle traction until the point being examined did not undergo further descent. International Continence Society (ICS) stages and individual POP-Q points were compared using a paired sample t test. A sample size of 32 provided 80% power to detect a clinically significant difference between office and operating room measurements (Sample Power, SPSS, 1997). Of 153 women, 76% received general endotracheal anesthesia and 21% laryngeal mask airway. With an increase of 3 cm, the apical compartment was significantly more prolapsed in the operating room (OR; p < 0.05); however, a comparison of the mean values demonstrated a larger change in means for all points except total vaginal length. When separated into anterior, apical, and posterior compartments, the ICS stages were systematically different in the OR than in the office for all stages (p < 0.0005). Neuromuscular blockade leads to significantly greater increases in POP-Q examination measurements compared with the office measurements, and this increase is most pronounced apically.

Laparoscopic Appendectomy in Pregnant Women: Experience in Chittagong, Bangladesh

Surgery may be needed during pregnancy for nonobstetric reasons, most commonly appendicitis, and laparoscopy is considered as safe as the open method, for both mother and fetus. The aim of the present study was to emphasize the feasibility of laparoscopic appendectomy during pregnancy in a developing country, and also to report the first study of its kind from Bangladesh. From 7 October 2005 to 6 October 2010, 31 pregnant women were diagnosed with acute appendicitis. Diagnoses were based on clinical suspicion supported by ultrasonogram. Under general endotracheal anesthesia, laparoscopy was done in all 31 cases. One gynecologist was always present to monitor the conditions of the fetus preoperatively and postoperatively. Feeding was allowed 6h after surgery, and the majority of the patients were discharged on the second postoperative day. Age, gestational period, operative time, hospital stay, maternal and fetal outcome, and complications were evaluated. Age ranged from 19 to 35years and gestational period ranged from 6 to 31weeks. Right lower quadrant pain was the presenting complaint in majority of cases. Average operative time was 34±10.19min, and there were no conversions to open surgery. There were no intraoperative or immediate postoperative hazards. Postoperative recovery was uneventful in all cases. Histopathology of 30 cases confirmed appendicitis. One patient, whose fetus was at 12weeks gestation at the time of the appendectomy had a spontaneous abortion 1month later. There were no adverse outcomes during the follow-up period. Laparoscopy is a safe and effective technique for the treatment of appendicitis during pregnancy and can be performed in a developing country.

Systemic air embolism during percutaneous core needle biopsy of the lung: frequency and risk factors

BackgroundDetection of risk factors for an air embolism in the left atrium, left ventricle, or systemic circulation (systemic air embolism, SAE) during a percutaneous core needle biopsy (PCNB) of the thorax.MethodsIn a retrospective observational study, all PCNBs of the thorax in 610 patients between 2007 and 2009 were analyzed. The SmartStep™ technique (General Electric) was used for the biopsy, with which the examiner can prepare a batch of three 1.25-mm or 2.5-mm collimated slices within a second using a foot switch in the CT room to check the needle position. The image data thus generated and the control CT scans that followed were examined retrospectively for the presence of intravascular air. Intravascular air was defined as two or more adjacent voxels with absorption values of < -200 HU in the left atrium, left ventricle, aorta, or arteries during or after the procedure. The univariate statistical analysis of categorical variables was made using 2 by 2 tables and the Fisher test. The groups were compared using the Mann-Whitney test. Finally, a multivariate logistic regression analysis was used to identify independent risk factors for the occurrence of an SAE.ResultsThe radiological incidence of an SAE during a PCNB was 3.8% (23/610 patients), whereas the clinically apparent incidence was 0.49%. Two patients developed clinical symptoms consisting of transient hemiplegia or transient amaurosis; one died due to a fatal SAE of the coronary arteries. The mortality was thus 0.16%. The depth of the needle in the lesion (Wald: 6.859), endotracheal anesthesia (Wald: 5.721), location of the lesion above the level of the left atrium (Wald: 5.159), and prone position of the patients (Wald: 4.317) were independent risk factors for the incidence of an SAE (p < 0.05 each). Using explorative criteria, the acute angle of the needle to the tumor surface, and the transition of ventilated lung were independent factors. The frequency of biopsies, needle penetration depth, and tumor location near the diaphragm or in the lower lobe also played a subordinate role, not however, the needle penetration depth through the lung.ConclusionIf possible, the PCNB should be performed under local anesthesia. We recommend avoiding endotracheal anesthesia and prone position. Whenever possible, patients should be positioned on the back in such a way that the tumor is lower than the left atrium. The tip of the needle should be within the tumor during the biopsy procedure.

Relationship between positive end‐expiratory pressure and internal jugular vein cross‐sectional area

Application of positive end-expiratory pressure (PEEP) has been used to increase the cross-sectional area (CSA) of the right internal jugular vein (IJV) in order to facilitate catheterisation. We aimed to determine the PEEP level at which the maximum increase of CSA occurred. We enrolled 60 American Society of Anesthesiologists physical status I and II patients undergoing general endotracheal anaesthesia. The CSA was measured in the supine position with no PEEP (control condition, P0) and after applying five different PEEPs in random order: 3 (P3), 6 (P6), 9 (P9), 12 (P12), and 15 (P15) cm H(2) O. Ultrasound was used to measure and record the CSA of the right IJV at the level of the cricoid cartilage. All PEEP levels increased the CSA of the right IJV relative to the control (all P < 0.05). On average, P3, P6, P9, P12, and P15 increased the CSA by 21.5, 37.4, 51.9, 66.5, and 72.4%, respectively. There was no significant increase in CSA above a PEEP of 12 cm H(2) O. The application of PEEP effectively increases the CSA of the right IJV. The PEEP giving the largest CSA is 12 cm H(2) O.

VARIOUS TYPES OF ANAESTHESIA WITH XENON IN CHILDREN

Since 2010 till 2011 years by authority of Ministry of Health and social development of Russian Federation the clinical trial IIIA on evaluation of xenon efficacy and safety in anaesthesia in children (ASA I–III) with different surgical diseases has been performed. 60 anaesthesias with xenon in children at the age of 1–18 years were made: face mask — 3 (5%), laryngeal mask — 9 (15%), endotracheal — 48 (80%). Face mask monoanaesthesia with xenon has prolonged duration, difficulties in maintenance of outline airtightness and is expensive because of gas consumption, so this method was defined as unpromising. The optimal anaesthesia with xenon is laryngeal mask or endotracheal anaesthesia. Before all types of anaesthesia premedication with 0,1% atropine sulfate must be performed. Induction and initial anaesthesia in children younger than 5 years old should be performed with sevoflurane through face mask, in children older than 5 years — with propofol. The analgesia with xenon concentration in respiratory-anaesthesia mixture is insufficient and requires the intensification by intravenous phentanylum.

Postadenoidectomy hemorrhage: A two-year prospective study

Although postoperative complications are rare, postadenoidectomy hemorrhage is one of the most frequent. The aim of this prospective study was to evaluate the incidence and timing of postadenoidectomy hemorrhage requiring hemostatic control under endotracheal anesthesia. A two-year prospective study of patients undergoing inpatient adenoidectomy, with (n = 462) or without tonsillectomy (n = 589), was undertaken. Surgery was performed in endotracheal anesthesia using an adenoid curette. Every bleeding event which needed procedure in general anesthesia for its treatment was recorded. The timing of postadenoidectomy hemorrhage was classified as primary or secondary. Severe bleeding following adenoidectomy with tonsillectomy which needed hemostatic control under endotracheal anesthesia occurred in only 0.19% (2/1051) patients (average age = 7.5 years). Postadenoidectomy hemorrhage was primary in both of the patients. Severe postoperative hemorrhage requiring hemostasis under endotracheal anesthesia can be expected in a small number of children undergoing adenoidectomy with tonsillectomy.

Ultrasound evaluation of uterine scar after cesarean section.

Introduction:The rate of attempted vaginal birth after previous cesarean delivery has decreased, while the success rate of such births increased. Advances in surgical techniques, the development of anesthesiology services, particularly endotracheal anesthesia, very quality postoperative care with cardiovascular, respiratory and biochemical resuscitation, significantly reduce maternal mortality and morbidity after cesarean section. Progress and development of neonatal services, and intensive care of newborns is enabled and a high survival of newborn infants. Complications after cesarean section were reduced, and the introduction of prophylaxis and therapy of powerful antibiotics, as well as materials for sewing drastically reduce all forms of puerperal infection.Goal:Goal was to establish a measurement value of the parameters that are evaluated by ultrasound.Material and methods:Each of the measured parameters was scored. The sum of points is shown in tables. Based on the sum of points was done an estimate of the scar on the uterus after previous caesarian section and make the decision whether to complete delivery naturally or repeat cesarean section. We conducted a prospective study of 108 pregnant women. Analyzed were: shape scar thickness (thickening), continuity, border scar out, echoing the structure of the lower uterine segment and scar volumeResults:The study showed that scar thickness of 3.5 mm or more, the homogeneity of the scar, scar triangular shape, qualitatively richer perfusion, and scar volume verified by 3D technique up to10 cm are attributes of the quality of the scar.Conclusion:Based on the obtained results we conclude that ultrasound evaluation of the quality of the scar has practical application in the decision on the mode of delivery in women who had previously given birth by Caesarean section.