Review of evidences for management of rapid sequence spinal anesthesia for category one cesarean section, in resource limiting setting

Abstract

Background Globally obstetric anesthesia is being done under spinal and epidural than general anesthesia (GA) for most caesarean sections (CSs). This is because GA is associated with failed endotracheal intubation and aspiration of gastric contents. Eventhough general anesthesia is the fastest method for anesthetizing a category 1 cesarean section, it is associated with increased maternal mortality and morbidity. Spinal anesthesia is the preferred regional technique for cesarean section but failure sometimes occurs. To minimize the time factor of spinal anesthesia as well as to avoid the side effects of general anesthesia ‘rapid sequence spinal ‘(RSS) has developed as a novel approach in cases of category one cesarean sections. Methods The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions. Discussion Neuraxial anesthetic techniques have several advantages which include low risk of aspiration and failed intubation, avoidance of central nervous system (CNS) and respiratory depressant drugs, the ability to maintain a wakeful state of mother enjoying the experience of delivery of baby and also lower incidence of blood loss. ‘Rapid sequence spinal’ described to minimize anesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anesthesia if there are delays or problems. To do rapid sequence spinal anesthesia safely and timely, cooperative work is mandatory with good team relation for those simultaneous and necessary tasks. Conclusion The choice of anesthetic in Cesarean section has long been recognized as one of prime importance, because there are two lives to safeguard instead of one. A balance must be struck between the anesthetic dictated by the general condition of the mother and that suited to the needs of the fetal respiratory system.

Comparison of postoperative pulmonary outcomes in patients undergoing cesarean section under general and spinal anesthesia: A single-center audit

“…[ 18 ] Although GA provided faster surgical conditions for LSCS than RA for category 1 LSCS in spite of higher morbidity and mortality, rapid sequence spinal anesthesia is now gaining momentum in many centers. [ 19 20 ] Patients undergoing LSCS under GA had more blood loss and had a larger proportion of newborns with 5-min Apgar scores <7 for spinal group. [ 21 ] Fernandes and Dyer emphasized that urgent LSCS required an individualized approach and the type of anesthesia should be based not only upon urgency of LSCS but also patient factors.…”

Perbandingan Hipotensi Antara Anestesi General dan Anestesi Spinal pada Seksio Sesarea

“…The Royal College of Anasthetist audit book menyarankan bahwa kurang dari 15% keadaan darurat dalam persalinan serta kurang dari 5% seksio sesarea elektif sebaiknya dilakukan menggunakan anestesi general (Adhikari, Lakhe and Adhikari, 2019). Anestesi regional lebih banyak digunakan dibandingkan anestesi general dikarenakan dapat menghindari risiko terjadinya kegagalan intubasi endotrakea serta kemungkinan terjadinya aspirasi isi lambung pada anestesi general, meskipun anestesi general dianggap sebagai metode anestesi tercepat dalam keadaan darurat karena dapat menghindari kemungkinan adanya kegagalan dari anestesi regional (Agegnehu, Gebregzi and Endalew, 2020). Penggunaan anestesi spinal memungkinkan ibu untuk tetap terjaga, namun berkaitan dengan blokade simpatis, yang mana efek otonom ini dapat memprovokasi terjadinya hipotensi dan penurunan perfusi uteroplasenta (Flora, Redjeki and Wargahadibrata, 2014).…”