Emergency Caesarean section: best practice*

Abstract

Good multidisciplinary communication is crucial to the safe management of women requiring non-elective Caesarean section. Anaesthetists should participate actively in resuscitation of the fetus in utero; relief of aortocaval compression is paramount. Epidural top-up with levobupivacaine 0.5% is the anaesthetic of choice for women who have been receiving labour epidural analgesia. If epidural top-up fails to provide bilateral light touch anaesthesia from S5 -T5, a combined spinalepidural technique with small intrathecal dose of local anaesthetic is a useful approach. Preeclampsia is not a contra-indication to single-shot spinal anaesthesia, which is the technique of choice for most women presenting for Caesarean section without an epidural catheter in situ. Induction and maintenance doses of drugs for general anaesthesia should not be reduced in the belief that the baby will be harmed. Early postoperative observations are geared towards the detection of overt or covert haemorrhage.

Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

“…1,10 However, in anecdotal reports on SA following failed epidural anesthesia for intrapartum CD, concerns were raised that this technique may result in a higher incidence of high or total spinal block. [3][4][5][6][7][8] Also, a series of three patients with high spinal blocks after continuous ELA without top-up doses (comparable with our SA group) has been reported.…”

“…Although it has been generally agreed that spinal anesthesia (SA) is the preferred anesthetic technique for Cesarean delivery (CD), epidural anesthesia is advised when an epidural catheter is already in place. 1 However, the efficacy of epidural anesthesia has been reported as inferior to that of SA in both elective and emergency situations. 1,2 Although it has been associated with a high incidence of deleterious effects, such as high-level or total spinal block, respiratory insufficiency, and hypotension [3][4][5][6][7][8] an increased use of SA for intrapartum CD following epidural labor analgesia (ELA) has been observed.…”

“…1 However, the efficacy of epidural anesthesia has been reported as inferior to that of SA in both elective and emergency situations. 1,2 Although it has been associated with a high incidence of deleterious effects, such as high-level or total spinal block, respiratory insufficiency, and hypotension [3][4][5][6][7][8] an increased use of SA for intrapartum CD following epidural labor analgesia (ELA) has been observed. 2,9 In our practice, patients who present for intrapartum CD, after receiving an epidural catheter for pain relief during labor, routinely receive SA after the epidural catheter is removed without an attempt to administer local anesthetic to convert ELA to epidural surgical anesthesia (ESA).…”

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

“…In comparison, many units in the UK have adopted a four-point classification of urgency [15]. According to that classification, some of the patients we recruited would have been be classified as category 3, which in the UK might not classified as 'true emergencies' [16]. However, we decided to recruit all nonelective cases for a number of reasons.…”

Comparison of Patient Satisfaction Between General and Spinal Anaesthesia in Emergency Caesarean Deliveries

“…Preoperative anxiety may increase if the mode of anaesthesia applied is different from the patient's anticipation. General or spinal anaesthesia is preferred to decrease the delay time in emergency caesarean deliveries (1,13,14). General anaesthesia has more risks than regional anaesthesia; however, it is preferred in urgent or emergency caesarean deliveries or when spinal anaesthesia is contraindicated (7,8,15).…”