What is the role of anesthesia in cesarean delivery (C-section)?

Updated: Dec 14, 2018
  • Author: Hedwige Saint Louis, MD, MPH, FACOG; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

The anesthesiologist will review regional anesthetic techniques. Regional anesthesia is used for 95% of planned cesarean deliveries in the United States. The 3 main regional anesthetic techniques are spinal, epidural, and combined spinal epidural. [72] Every patient is evaluated for general anesthesia in case an emergency should arise and establishment of an airway becomes necessary.

A review by Afolabi et al found that patients undergoing local anesthetic techniques were found to have a significantly lower difference between preoperative and postoperative hematocrit levels when compared with patients undergoing general anesthesia. Women having either an epidural anesthesia or spinal have a lower estimated maternal blood loss. [73]

After placement of the regional anesthetic, monitor the fetus until an adequate surgical level has been achieved. When the level of anesthesia is adequate, the skin can be prepared either with an iodine scrub or with 4% chlorhexidine. Before making the initial incision, grasp the patient’s skin bilaterally with an instrument such as an Allis clamp at the level of and above the incision to confirm anesthesia up to the level of T4. This ensures that the anesthetic level is appropriate.

The dermatomal level of anesthesia required for cesarean delivery is higher than that required for labor analgesia. A sensory block to the 10th thoracic dermatome is sufficient to achieve analgesia for labor, but for cesarean, the anesthetic level must be extended cephalad to at least the fourth thoracic dermatome to prevent nociceptive input from the peritoneal manipulation.

In patients who require a cesarean delivery secondary to a problem arising during labor, the preparation follows essentially the same steps previously outlined. The only major variation occurs if a patient requires general anesthesia prior to the procedure. In that situation, before intubation, the patient should be prepped and draped and the surgical team should be ready to begin as soon as the patient’s airway is secured.


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