Anesthetic Care for Cesarean Delivery
This article is based on "Practice Guidelines for Obstetric Anesthesia. An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology".
The decision to use a particular anesthetic technique for cesarean delivery should be individualized, based on anesthetic, obstetric, or fetal risk factors (e.g., elective vs. emergency), the preferences of the patient, and the judgment of the anesthesiologist.
Uterine displacement (usually left displacement) should be maintained until delivery regardless of the anesthetic technique used.(effective approach to managing hypotension as it helps in directly relieving the aortocaval compression)
Consider selecting neuraxial techniques in preference to general anesthesia (GA) for most cesarean deliveries. (higher Apgar scores at 1 and 5 min for epidural anesthesia when compared with GA. When spinal anesthesia is compared with epidural anesthesia, RCTs are equivocal.)
If spinal anesthesia is chosen, use pencil-point spinal needles instead of cutting-bevel spinal needles.
For urgent cesarean delivery, an indwelling epidural catheter may be used as an alternative to initiation of spinal or general anesthesia.
General Anesthesia may be the most appropriate choice in some circumstances (e.g., profound fetal bradycardia, ruptured uterus, severe hemorrhage, and severe placental abruption).
IV fluid preloading or coloading may be used to reduce the frequency of maternal hypotension after spinal anesthesia for cesarean delivery.
Do not delay the initiation of spinal anesthesia in order to administer a fixed volume of IV fluid.
Either IV ephedrine or phenylephrine may be used for treating hypotension during neuraxial anesthesia.
In the absence of maternal bradycardia, consider selecting phenylephrine because of improved fetal acid–base status in uncomplicated pregnancies.
