Skip to main content
SpringerLink
Log in

General Anaesthesia for Caesarean Section

  • Chapter
  • First Online:
Anesthesia for Cesarean Section

  • 1287 Accesses

Abstract

General anaesthesia for caesarean section is a challenging scenario that the majority of the anaesthesiologists may have to manage although its occurence became rare when compared with spinal or epidural techniques. Two different clinical vignettes can summarize the most frequent cases: the scheduled caesarean delivery for non-favourable vaginal delivery planning and the emergency caesarean procedure for severe altered foetal or maternal status. If the operational procedure for both situations is similar, the environmental system differs dramatically. The holy grail of the emergency caesarean delivery is to combine a very short decision-to-delivery time period and maximizing the safety of every procedure step. To achieve this goal, optimal teaching aims at reducing the risk of cognitive overload by mastering the different technical and non-technical skills involved. Improving the initial teaching and skill retention is particularly important given the low number of general anaesthesia for caesarean section an anesthesiologist has to give in the actual context.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gibbons L, Belizan JM, Lauer JA, Betran AP, Merialdi M, Althabe F. Inequities in the use of cesarean section deliveries in the world. Am J Obstet Gynecol. 2012;206:331. e1–19

    Article  PubMed  Google Scholar 

  2. Kochanek KD, Kirmeyer SE, Martin JA, Strobino DM, Guyer B. Annual summary of vital statistics: 2009. Pediatrics. 2012;129:338–48.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bragg F, Cromwell DA, Edozien LC, Gurol-Urganci I, Mahmood TA, Templeton A, van der Meulen JH. Variation in rates of caesarean section among English NHS trusts after accounting for maternal and clinical risk: cross sectional study. BMJ. 2010;341:c5065.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tsen LC. Anesthesia for ceasarian delivery, Chestnut’s Obstetric Anesthesia: Principles and Practice. 5th ed. Elsevier. pp. 545–603.

    Google Scholar 

  5. Hanley GE, Janssen PA, Greyson D. Regional variation in the cesarean delivery and assisted vaginal delivery rates. Obstet Gynecol. 2010;115:1201–8.

    Article  PubMed  Google Scholar 

  6. Clark SL, Belfort MA, Hankins GDV, Meyers JA, Houser FM. Variation in the rates of operative delivery in the United States. Am J Obstet Gynecol. 2007;196:526. e1–5

    PubMed  Google Scholar 

  7. Pallasmaa N, Ekblad U, Gissler M. Severe maternal morbidity and the mode of delivery. Acta Obstet Gynecol Scand. 2008;87:662–8.

    Article  PubMed  Google Scholar 

  8. van Dillen J, Zwart JJ, Schutte J, Bloemenkamp KWM, van Roosmalen J. Severe acute maternal morbidity and mode of delivery in the Netherlands. Acta Obstet Gynecol Scand. 2010;89:1460–5.

    Article  PubMed  Google Scholar 

  9. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103:645–53.

    Article  PubMed  Google Scholar 

  10. 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. Anesthesiology. 2016;124:270–300.

    Google Scholar 

  11. Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Nickinovich DG, Rice LJ, Roizen MF, Twersky RS. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on preanesthesia evaluation. Anesthesiology. 2012;116:522–38.

    Article  Google Scholar 

  12. Pilkington S, Carli F, Dakin MJ, Romney M, De Witt KA, Doré CJ, Cormack RS. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74:638–42.

    Article  CAS  PubMed  Google Scholar 

  13. Kodali B-S, Chandrasekhar S, Bulich LN, Topulos GP, Datta S. Airway changes during labor and delivery. Anesthesiology. 2008;108:357–62.

    Article  PubMed  Google Scholar 

  14. Leboulanger N, Louvet N, Rigouzzo A, de Mesmay M, Louis B, Farrugia M, Girault L, Ramirez A, Constant I, Jouannic J-M, Fauroux B. Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method. Int J Obstet Anesth. 2014;23:35–9.

    Article  CAS  PubMed  Google Scholar 

  15. Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Obstetric Anaesthetists’ association, difficult airway society: obstetric Anaesthetists’ association and difficult airway society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015;70:1286–306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B. Prevalence and risk factors of severe obstetric haemorrhage. BJOG. 2008;115:1265–72.

    Article  CAS  PubMed  Google Scholar 

  17. Murphy DF, Nally B, Gardiner J, Unwin A. Effect of metoclopramide on gastric emptying before elective and emergency caesarean section. Br J Anaesth. 1984;56:1113–6.

    Article  CAS  PubMed  Google Scholar 

  18. Soltanifar S, Russell R. The National Institute for health and clinical excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. Int J Obstet Anesth. 2012;21:264–72.

    Article  CAS  PubMed  Google Scholar 

  19. Gordon HR, Phelps D, Blanchard K. Prophylactic cesarean section antibiotics: maternal and neonatal morbidity before or after cord clamping. Obstet Gynecol. 1979;53:151–6.

    CAS  PubMed  Google Scholar 

  20. Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol. 2007;196:455. e1–5

    Article  PubMed  Google Scholar 

  21. Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E, Morrison JC. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. Am J Obstet Gynecol. 2005;192:1864–8. discussion 1868–71

    Article  CAS  PubMed  Google Scholar 

  22. Wax JR, Hersey K, Philput C, Wright MS, Nichols KV, Eggleston MK, Smith JF. Single dose cefazolin prophylaxis for postcesarean infections: before vs. after cord clamping. J Matern Fetal Med. 1997;6:61–5.

    Article  CAS  PubMed  Google Scholar 

  23. Yildirim G, Gungorduk K, Guven HZ, Aslan H, Celikkol O, Sudolmus S, Ceylan Y. When should we perform prophylactic antibiotics in elective cesarean cases? Arch Gynecol Obstet. 2009;280:13–8.

    Article  PubMed  Google Scholar 

  24. Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. Br J Anaesth. 2007;99:581–6.

    Article  CAS  PubMed  Google Scholar 

  25. Hignett R, Fernando R, McGlennan A, McDonald S, Stewart A, Columb M, Adamou T, Dilworth P. A randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients. Anesth Analg. 2011;113:1098–102.

    Article  PubMed  Google Scholar 

  26. Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D. A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position. Anaesthesia. 2005;60:1064–7.

    Article  CAS  PubMed  Google Scholar 

  27. Ramkumar V, Umesh G, Philip FA. Preoxygenation with 20o head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth. 2011;25:189–94.

    Article  PubMed  Google Scholar 

  28. Zand F, Hadavi SMR, Chohedri A, Sabetian P. Survey on the adequacy of depth of anaesthesia with bispectral index and isolated forearm technique in elective caesarean section under general anaesthesia with sevoflurane. Br J Anaesth. 2014;112:871–8.

    Article  CAS  PubMed  Google Scholar 

  29. Robins K, Lyons G. Intraoperative awareness during general anesthesia for cesarean delivery. Anesth Analg. 2009;109:886–90.

    Article  PubMed  Google Scholar 

  30. Sanders RD, Avidan MS. Evidence is lacking for interventions proposed to prevent unintended awareness during general anesthesia for cesarean delivery. Anesth Analg. 2010;110:972–3. author reply 973–4

    Article  PubMed  Google Scholar 

  31. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MCM, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA. Safe surgery saves lives study group: a surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360:491–9.

    Article  CAS  PubMed  Google Scholar 

  32. Russell EC, Wrench I, Feast M, Mohammed F. Pre-oxygenation in pregnancy: the effect of fresh gas flow rates within a circle breathing system. Anaesthesia. 2008;63:833–6.

    Article  CAS  PubMed  Google Scholar 

  33. Murdoch H, Scrutton M, Laxton CH. Choice of anaesthetic agents for caesarean section: a UK survey of current practice. Int J Obstet Anesth. 2013;22:31–5.

    Article  CAS  PubMed  Google Scholar 

  34. Palahniuk RJ, Shnider SM, Eger EI. Pregnancy decreases the requirement for inhaled anesthetic agents. Anesthesiology. 1974;41:82–3.

    Article  CAS  PubMed  Google Scholar 

  35. Erden V, Erkalp K, Yangin Z, Delatioglu H, Kiroglu S, Ortaküz S, Ozdemir B. The effect of labor on sevoflurane requirements during cesarean delivery. Int J Obstet Anesth. 2011;20:17–21.

    Article  CAS  PubMed  Google Scholar 

  36. Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Curr Opin Anaesthesiol. 2015;28:240–6.

    Article  CAS  PubMed  Google Scholar 

  37. Gultekin H, Yildiz K, Sezer Z, Dogru K. Comparing the relaxing effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated myometrium in both pregnant and nonpregnant rats. Adv Ther. 2006;23:39–46.

    Article  CAS  PubMed  Google Scholar 

  38. Dogru K, Yildiz K, Dalgiç H, Sezer Z, Yaba G, Madenoglu H. Inhibitory effects of desflurane and sevoflurane on contractions of isolated gravid rat myometrium under oxytocin stimulation. Acta Anaesthesiol Scand. 2003;47:472–4.

    Article  CAS  PubMed  Google Scholar 

  39. McDonnell NJ, Paech MJ, Clavisi OM, Scott KL, ANZCA Trials Group. 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;17:292–7.

    Article  CAS  PubMed  Google Scholar 

  40. Cook TM, Woodall N, Frerk C. Fourth National Audit Project: major complications of airway management in the UK: results of the fourth National Audit Project of the Royal College of Anaesthetists and the difficult airway society. Part 1: anaesthesia. Br J Anaesth. 2011;106:617–31.

    Article  CAS  PubMed  Google Scholar 

  41. Spong AD, Vaughan DJ. Safe extubation of a parturient using an airway exchange technique. Int J Obstet Anesth. 2014;23:282–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d’Anesthésie—Réanimation Chirurgicale, Hôpitaux de Hautepierre, CCOM-Illkirch et CMCO-Schiltigheim, Strasbourg, France

    Pierre Diemunsch & Eric Noll

Authors
  1. Pierre Diemunsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Noll
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre Diemunsch .

Editor information

Editors and Affiliations

  1. Dept of Anesthesiolgy, Città di Roma Hospital, Rome, Italy

    Giorgio Capogna

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Diemunsch, P., Noll, E. (2017). General Anaesthesia for Caesarean Section. In: Capogna, G. (eds) Anesthesia for Cesarean Section. Springer, Cham. https://doi.org/10.1007/978-3-319-42053-0_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42053-0_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42051-6

  • Online ISBN: 978-3-319-42053-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation