Anaesthesia for lower-segment caesarean section: Changing perspectives

Abstract

The number of caesarean sections has increased over the last two decades, especially in the developed countries. Hence, it has increasingly become a greater challenge to provide care for the parturient, but this has given obstetric anaesthetists a greater opportunity to contribute to obstetric services. While caesarean deliveries were historically performed using general anaesthesia, there is a recent significant move towards regional anaesthesia. Unique problems that patients with obesity and pre-eclampsia present will be discussed in the present article. New medications and devices now used in obstetric anaesthesia will change the practice and perspectives of our clinical practice.

“Comparative Evaluation of Etomidate and Thiopentone Sodium With Rocuronium for Rapid Sequence Intubation in Pregnant Patients Undergoing Lower Segment Caeserean Section (Lscs)” a Comparative Study.

“…29 Obstretics patients undergoing caesarean section under general anaesthesia require rapid sequence induction and intubation (RSII) due to the high risk of aspiration. High rates of caesarean section surgeries are encountered by anaesthesiologists now a days.…”

“…Because the airway is unprotected during this time, it is the most critical period during which aspiration of gastric contents is likely to occur. 29 The depolarizing neuromuscular blocking agent, succinylcholine has been the drug of choice for rapid sequence induction and intubation (RSII) and anticipated difficult intubations for its short and rapid acting properties. Nothing had yet replaced succinylcholine in the scenarios of difficult intubation before yet, with advent of Rocuronium antagoinist (ORG-25969, sugamedax) that chelates the drug and act as the reversal agent, Rocuronium can also be used in difficult intubation situations in RSII.…”

General endotracheal anaesthesia for lower-segment caesarean section: a vanishing art?

“…Recently, researchers have suggested that rocuronium-sugammadex combination may replace succinylcholine in the near future 10,11 . Sugammadex, a selective relaxant-binding agent, antagonizes the effects induced by rocuronium on muscle tissue and quickly resolves neuromuscular blockade.…”

Rising rates of caesarean section: an indicator of defensive medicine practiced by obstetricians

“…4 This increase is seen more in primigravidae compared to multigravida which compromises their obstetric future in the form of vaginal delivery, as patients who have undergone caesarean section once are less likely to opt for vaginal birth after caesarean (VBAC) as clinicians and patients are not ready to take risk of scar rupture and high perinatal mortality. 5 This results in exponential increase in CS.…”