Review Article

Current anesthesıa for Cesarean Sectıon

Demet Dogan Erol* and Ismail Aytac

Published: 29 October, 2018 | Volume 1 - Issue 2 | Pages: 061-066

The choice of anesthesia for cesarean section should depend on the urgency of the procedure, in addition to the condition of the mother and fetus. It is widely accepted that regional anesthesia for cesarean section is preferable to general anesthesia. Regional techniques have several advantages. They lessen the risk of gastric aspiration, avoid the use of depressant anesthetic drugs and allow the mother to remain awake during delivery. The most common type of regional anesthesia for cesarean section is spinal anesthesia because of its simplicity, cost-effectiveness and speed of onset. It is suitable for cases of an emergent cesarean delivery. Hypotension during spinal anesthesia is a common that is associated with morbidity for both mother and fetus. Epidural anesthesia is preferred when physicians want to minimize the maternal hypotension or when intense motor blockage of the thoracoabdominal segments is not desired. General anesthesia still leads to a higher maternal mortality and should be reserved for absolute emergencies and cases where neuroaxial blockade is contraindicated.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001011 Cite this Article Read Full Article PDF


  1. Bailit JL, Dooley SL, Peaceman. Risk adjustment for interhospital comparison of primarycesarean rates. Obstet Gynecol 1999; 93: 1025-1030. Ref.: https://goo.gl/xoZFiW
  2. Ueyama H. Controversial issues regarding general anesthesia for cesarean section. Masui. 2010; 59: 357-356. Ref.: https://goo.gl/cYMyUb
  3. McDonnell NJ, Paech MJ, Clavisi OM, Scott KL. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int J Obstet Anesth. 2008; 17: 292–297. Ref.: https://goo.gl/sZ5dF9
  4. Birnbach DJ, Gatt SP, Datta S. Anesthesia for Presumed Fetal Jeopardy; Textbooks of Obstetric Anesthesia. Philadelphia; Churchill Livingstone. 2000.
  5. Abu-Halaweh SA, Massad IM, Abu-Ali HM, Badran IZ, Barazangi BA, et al. Rapid sequence induction and intubation with 1 mg/kg rocuronium bromide in cesarean section, comparison with suxamethonium. Saudi Med J. 2007; 28: 1393-1396. Ref.: https://goo.gl/Sj5WPM
  6. Wierdo JMH, de Wit APM, Kuizenga K, Agoston S. Clinical observations on the neuromuscular blocking action of Org 9426, a new steroidal non-depolarizing agent. Br J Anaesth. 1990; 64: 521-523. Ref.: https://goo.gl/btDzsf
  7. Abouleish E, Abboud T, Lechevalier T, et al. Rocuronium (Org 9426) for Caesarean section. Br J Anaesth 1994; 73: 336-341. Ref.: https://goo.gl/DNX1Mj
  8. Barker I, Langton JA, Wilson IG, Smith G. Movements of the vocal cords in induction of anaesthesia with thiopentone or propofol. Br J Anaesth. 1992; 69: 23-25. Ref.: https://goo.gl/dBVy83
  9. Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg. 1992; 75: 788-793. Ref.: https://goo.gl/hZhu4E
  10. Helbo-Hansen S, Ravlo 0, Trap-Andersen S. The influence of alfentanil on intubating conditions after priming with vecuronium. Acta Anaesthesiol Stand. 1988; 32: 41-44. Ref.: https://goo.gl/DawDNC
  11. Baraka AS, Sayyid SS, Assaf BA. Thiopental-rocuronium versus ketamine-rocuronium for rapid-sequence intubation in parturients undergoing cesarean section. Anesth Analg. 1997; 84: 1104-1107. Ref.: https://goo.gl/XDXDXz
  12. Leykin Y, Pellis T, Zannier G. Thiopental--ketamine association and low dose priming with rocuronium for rapid sequence in duction of anaesthesia for elective cesareum section. Minerva Anestesiol. 2006; 72: 683-688. Ref.: https://goo.gl/BP8PPn
  13. Baraka A, Jabbour S, Tabboush Z, Sibai A, Bijjani A, et al. Onset of vecuronium neuromuscular block is more rapid in patients undergoing Caesarean section. Can J Anaesth. 1992; 39: 135-138. Ref.: https://goo.gl/KtJsSx
  14. Marshall BE, Longnecker DE. General anesthetics. In: Handman JG, Limbird LE, eds The pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, 1996; 307-328.
  15. Stevens JB, Vescovo MV, Harris KC, Walker SC, Hickey R. Tracheal intubation using alfentanil and no muscle relaxant: is the choice of hypnotic important. Anesth Analg. 1997; 84: 1222–1226. Ref.: https://goo.gl/Xr2bCs
  16. Soares de Moura R, Silva GA, Tano T, Resende AC. Effect of propofol on human fetal placental circulation. Int J Obstet Anesth. 2010; 19: 71-76. Ref.: https://goo.gl/PrFtL2
  17. Birnbach DJ, Gatt SP, Datta S. Anesthesia for Presumed Fetal Jeopardy; Textbooks of Obstetric Anesthesia. Philadelphia; Churchill Livingstone. 2000.
  18. Glosten B. Anesthesia for Obstetrics. In: Miller RD(ed). Miller's Anesthesia. 5th edition. Philadelphia: Churchill Livingstone, 2000. 2024-2068.
  19. Levy DM. Emergency Caesarean section: best practice. Anaesthesia. 2006; 61: 786-791. Ref.: https://goo.gl/Hkgz9F
  20. Baki Dogan E, Dogan Erol D, Demirel R, Erdogan Y. Maternal and fetal effects of intratecal bupivacaine and levobupivacaine for caserian section. ARUD: Official Journal of Anesthesiology and Reanimation Speciallty Society. 2010; 18: 19-10.
  21. ASA Task Force on Practice Guidelines for Obstetrical Anesthesia. Practice Guidelines for Obstetrical Anesthesia. Anesthesiology. 1999; 90: 600-611.
  22. Bader AM, Tsen LC, Camann WR, Nephew E, Datta S. Clinical effects and maternal and fetal plasma concentrations of 0.5% epidural levobupivakaine versus bupivacaine for cesarean delivery. Anesthesiology. 1999; 90: 1596-1601. Ref.: https://goo.gl/cLK3jM
  23. Parpaglioni R, Frigo MG, Lemma A, Sebastiani M, Barbati G, et al. Minimum local anaesthetic dose (MLAD) of intrathecal levobupivacaine and ropivacaine for Caesarean section. Anaesthesia. 2006; 61: 110-115. Ref.: https://goo.gl/zmz8zB
  24. Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, et al. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003; 91: 684-689. Ref.: https://goo.gl/uZ6RQU
  25. Celleno D, Parpaglioni R, Frigo MG, Barbati G. Intrathecal levobupivacaine and ropivacaine for cesarean section. New perspectives. Minerva Anestesiol. 2005; 71: 521-525. Ref.: https://goo.gl/dSZLoC
  26. Camorcia M, Capogna G, Berritta C, Columb MO. The relative potencies for motor block after intrathecal ropivacaine, levobupivacaine, and bupivacaine. Anesth Analg. 2007; 104: 904-907. Ref.: https://goo.gl/D1z1wU
  27. Brizgys RV, Dailey PA, Shnider SM, Kotelko DM, Levinson G. The incidence and neonatal effects of maternal hypotension during epidural anesthesia for cesarean section. Anesthesiology. 1987; 67: 782-785. Ref.: https://goo.gl/9jQxp4
  28. Ramanathan S, Grant GJ. Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section. Acta Anaesthesiol Scand. 1988; 32: 559-565. Ref.: https://goo.gl/dRo3Vx
  29. Gutsche BB. Prophylactic ephedrine preceding spinal analgesia for cesarean section. Anesthesiology 1976; 45: 462-465. Ref.: https://goo.gl/SrPvQu
  30. Bremerich DH, Fetsch N, Zwissler BC, Meininger D, Gogarten W, et al. Comparison of intrathecal bupivacaine and levobupivacaine combined with opioids for Caesarean section. Curr Med Res Opin. 2007; 23: 3047-3054. Ref.: https://goo.gl/qBEsmm
  31. Rout CC, Rocke DA. Prevention of hypotension following spinal anesthesia for cesarean section. Int Anesthesiol Clin 1994; 32: 117–135. Ref.: https://goo.gl/tD2f4c
  32. Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology 1993; 79: 262–269. Ref.: https://goo.gl/JmCj3T
  33. Burns SM, Cowan CM, Wilkes RG. Prevention and management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice. Anaesthesia 2001; 56: 794–798. Ref.: https://goo.gl/LwwBGW
  34. Ralston DH, Shnider SM, DeLorimier AA. Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnant ewe. Anesthesiology 1974; 40: 354–370. Ref.: https://goo.gl/o8zgiu
  35. James FM III, Greiss FC Jr, Kemp RA. An evaluation of vasopressor therapy for maternal hypotension during spinal anesthesia. Anesthesiology 1970; 33: 25–34. Ref.: https://goo.gl/RTXZPz
  36. Alahuhta S, Räsänen J, Jouppila P, Jouppila R, Hollmén AI. Ephedrine and phenylephrine for avoiding maternal hypotension due to spinal anaesthesia for caesarean section. Int J Obstet Anesth 1992; 1: 129–134. Ref.: https://goo.gl/7DUTbY
  37. Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for caesarean section. Br J Anaesth 1996; 76: 61–65. Ref.: https://goo.gl/57GPnQ
  38. Hall PA, Bennett A, Wilkes MP, Lewis M. Spinal anaesthesia for caesarean section: comparison of infusions of phenylephrine and ephedrine. Br J Anaesth 1994; 73: 471–474. Ref.: https://goo.gl/1JHyuC
  39. Moran DH, Perillo M, LaPorta RF, Bader AM, Datta S. Phenylephrine in the prevention of hypotension following spinal anesthesia for cesarean delivery. J Clin Anesth 1991; 3: 301–305. Ref.: https://goo.gl/xQZp3G
  40. Güngördük K, Asicioglu O, Celikkol O, Olgac Y, Ark C. Use of additional oxytocin to reduce blood loss at elective caesarean section: A randomised control trial. Aust N Z J Obstet Gynaecol 2010; 50: 36-39. Ref.: https://goo.gl/7vu4Ai
  41. Sheehan SR, Montgomery AA, Carey M, McAuliffe FM, Eogan M, et al. Oxytocin bolus versus oxytocin bolus and infusion for control of blood loss at elective caesarean section: double blind, placebo controlled, randomised trial. BMJ 2011; 343: d4661. Ref.: https://goo.gl/nzFj9x
  42. Balki M, Ronayne M, Davies S, Fallah S, Kingdom J, et al. Minimum oxytocin dose requirement after cesarean delivery for labor arrest. Obstet Gynecol 2006; 107: 45-50. Ref.: https://goo.gl/PgoA4V
  43. George RB, McKeen D, Chaplin AC, McLeod L. Up-down determination of the ED(90) of oxytocin infusions for the prevention of postpartum uterine atony in parturients undergoing Cesarean delivery. Can J Anaesth 2010; 57: 578-582. Ref.: https://goo.gl/9JaZt4
  44. Lavoie A, McCarthy RJ, Wong CA. The ED90 of prophylactic oxytocin infusion after delivery of the placenta during cesarean delivery in laboring compared with nonlaboring women: an up-down sequential allocation dose-response study. Anesth Analg 2015; 121: 159-164. Ref.: https://goo.gl/776xAg

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