Spinal Anesthesia for Cesarean Section
The rates of cesarean section have significantly increased worldwide over the past three decades. The choice of anesthetic depends on a number of factors: maternal, fetal, surgical, and anesthetic. Neuraxial techniques are the preferred method of anesthes
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Spinal Anesthesia for Cesarean Section Sarah Armstrong
4.1
Introduction
As the rates of cesarean delivery have escalated, so have the rates of neuraxial anesthesia for cesarean delivery. Pregnant women are known to be at increased risk of morbidity and mortality from the complications of general anesthesia including awareness, failed intubation and/or ventilation, hypoxia and aspiration of gastric contents [1–3]. Neuraxial techniques (spinal, epidural and combined spinal- epidural) are well established as the preferred and safest methods of anesthesia for both planned and emergency cesarean section. The Royal College of Anaesthetists currently recommends that 95% of elective cesarean sections and 85% of emergency cesarean sections are performed under neuraxial anesthesia [3]. Neuraxial anesthesia for cesarean delivery can be provided using a range of techniques as listed below: • • • • •
Single-shot spinal anesthesia (SSS) Continuous spinal anesthesia Combined spinal-epidural anesthesia (CSE) Low-dose or sequential CSE anesthesia Epidural anesthesia
In this chapter, we will focus on the first two—single-shot spinal and continuous spinal anesthesia.
S. Armstrong Frimley Health NHS Foundation Trust, Surrey, UK e-mail: [email protected] © Springer International Publishing Switzerland 2017 G. Capogna (ed.), Anesthesia for Cesarean Section, DOI 10.1007/978-3-319-42053-0_4
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4.2
S. Armstrong
Advantages of Neuraxial Anesthesia
As stated previously, neuraxial anesthesia not only reduces the risk of potential complications of general anesthesia but also has independent advantages over and above general anesthesia and these are listed in Table 4.1. The choice of specific neuraxial anesthetic technique will depend on a multitude of factors including local institutional guidelines, anesthetic and surgical experience and preference, clinical judgement and individual patient requirements. The block must provide adequate anesthesia and analgesia for the duration of the surgery and minimize perioperative discomfort [4]. In addition there are specific advantages of single-shot spinal and continuous spinal anesthesia. Both techniques allow a rapid onset of dense anesthesia. Riley et al. evaluated spinal versus epidural anesthesia for cesarean section and found that spinal anesthesia was associated with significantly shorter operating room times, with supplemental intraoperative intravenous (IV) analgesics and anxiolytics required more often in the epidural group (38%) than in the spinal group (17%) (p
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