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Anesthesia for Cesarean Section

(Originally posted on About Anesthesiology)

There is obviously some risk to the mother when a caesarean section is needed. From the anesthesia standpoint however, the incidence of complications has steadily decreased due to better techniques and monitoring. This is not to downplay the seriousness of a surgical procedure, only to reassure you that serious risks and complications are very rare.

The choice of what anesthetic is safe and appropriate depends on a number of factors. Some of these things include the reason for the caesarean section, whether the operation is an emergency, the medical status of the patient, the needs and wishes of the patient, the needs of the obstetrician performing the surgery, etc. What is right for one patient may not be right for another.

General goals in choosing anesthesia are (1) the safety of the mother; (2) the safety of the baby; (3) the comfort of the mother and (4) the ability to perform the surgery under that anesthetic technique.

There are two general categories of anesthesia for caesarean section - general anesthesia and regional anesthesia. Regional anesthesia includes both spinal and epidural techniques. General anesthesia is usually reserved for patients that must have anesthesia "right away" because their surgery is being done for a true emergency. In these situations, regional techniques can take too long to perform. However, there are some risks associated with general anesthesia that can be avoided with regional anesthesia. Therefore, regional anesthesia is almost universally preferred when time is not as much of a factor.

Regional anesthesia includes both spinal anesthesia and epidural anesthesia. They both result in the lower portion of your body becoming anesthetized (or "numb") so that the surgery can be completed without any pain. The fact that the mother can remain awake, see the baby and interact with the baby as soon as it is born and does not require a breathing tube are all advantages.

If you already have an epidural catheter in place for labor then it makes sense to utilize that catheter to give you anesthesia for a subsequent caesarean section.

If you don't already have an epidural in place, a spinal is an excellent choice for cesarean section. Generally a spinal is faster and simpler to place, works slightly faster and is less technically complicated.

There are some situations in which you might benefit from the extra effort required to put in an epidural - the most common is if the epidural catheter can be used for pain relief AFTER the operation. Whether there are any benefits in your specific case to having an epidural versus a spinal should be clearly explained to you before the operation when you are discussing your options with the anesthesiologist.

In addition to the numbness provided by a spinal or epidural, intravenous medications can be given for purposes of relaxation, sedation, etc. Some of these medications also tend to cause amnesia - and this may not be an effect that you desire especially if you want to remember the birth of your baby.

I personally don't use additional intravenous medications unless absolutely necessary. However, you should ask your anesthesiologist about this issue - especially if you want to avoid effects such as amnesia and sedation. You should be aware that you can ask for these kinds of medications to be withheld unless absolutely necessary, to be given only in very small dosages, or to be given no matter what (if for some reason you want to be sedated and not remember anything) - in most cases, it really is your choice.

General anesthesia does have some advantages: it can be given very quickly, blood pressure is more easily controlled, breathing is more easily controlled once the ability to breathe for the patient is obtained. There are some situations where general anesthesia is preferred because there is a medical reason not to do regional anesthesia.

Disadvantages of general anesthesia include the fact that the mother is unconscious and therefore unable to participate in the process of birth or interact with the baby once it is delivered. After the operation, general anesthesia wears off relatively quickly and can result in greater postoperative pain.

There are some significant risks associated with general anesthesia:

The main risk to the mother involves the fact that the anesthesiologist must secure and control the ability to breathe. Two things can occur as part of this process that involve risk ro the mother (and therefore to the baby too):

The first is that the breathing tube may be difficult to place in the correct place. Pregnancy makes this more difficult. Since this tube is required to breathe, there is great risk to the mother if it cannot be placed quickly and properly.

The second risk is that the mother may aspirate during the placement of this tube. Aspiration is when some of the contents of the stomach end up in the lungs. This can result in a serious pneumonia which can be life threatening as well.

Anesthesiologists use a number of special techniques and devices to decrease the risk of these events. They happen fair infrequently - but they are significant risks.This is why most prefer to use regional anesthesia when possible.

Also, general anesthesia does affect the newborn - at least a small amount. Another reason that regional anesthesia is preferred.

NEXT: Pain Relief after Cesarean Section

 

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