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Anaesthesia for urgent (grade 1) caesarean section.
Curr Opin Anaesthesiol. 2009 Jun; 22(3):352-6.CO

Abstract

PURPOSE OF REVIEW

We describe the different possible anaesthetic techniques for an emergency caesarean section. To choose the right method of anaesthesia may have major implications for mother, child and all involved personnel. The major controversy is whether one have other or better alternatives or both than general anaesthesia, with a rapid sequence induction technique, when the foetus is compromised.

RECENT FINDINGS

Recently published studies indicate that a top-up of a well functioning labour epidural is as fast as general anaesthesia, and that the top-up can be performed during preparation and transport. Spinal anaesthesia, when performed by skilled anaesthetists, is as fast or almost as fast as general anaesthesia with a very low failure rate. Combined spinal/epidural may have advantages, especially in high-risk cardiac patients, but is too time-consuming. General anaesthesia still seems to be the method of choice for most anaesthetists in extremely urgent settings. The major disadvantage with general anaesthesia is the risk of failure and the dramatic consequences of a 'cannot intubate, cannot ventilate' situation. Awareness is another concern, and the incidence varies from 0.26 to 1% in recent literature.

SUMMARY

Regional anaesthesia techniques such as a single-shot spinal or a top-up of a well functioning labour epidural analgesia are good alternatives to general anaesthesia in an emergency caesarean setting.

Authors+Show Affiliations

Department of Anaesthesia and Intensive Care, Asker and Baerum Hospital, Box 83, Rud N-1307, Norway. vegard.dahl@sabhf.noNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19434772

Citation

Dahl, Vegard, and Ulrich J. Spreng. "Anaesthesia for Urgent (grade 1) Caesarean Section." Current Opinion in Anaesthesiology, vol. 22, no. 3, 2009, pp. 352-6.
Dahl V, Spreng UJ. Anaesthesia for urgent (grade 1) caesarean section. Curr Opin Anaesthesiol. 2009;22(3):352-6.
Dahl, V., & Spreng, U. J. (2009). Anaesthesia for urgent (grade 1) caesarean section. Current Opinion in Anaesthesiology, 22(3), 352-6.
Dahl V, Spreng UJ. Anaesthesia for Urgent (grade 1) Caesarean Section. Curr Opin Anaesthesiol. 2009;22(3):352-6. PubMed PMID: 19434772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anaesthesia for urgent (grade 1) caesarean section. AU - Dahl,Vegard, AU - Spreng,Ulrich J, PY - 2009/5/13/entrez PY - 2009/5/13/pubmed PY - 2009/7/17/medline SP - 352 EP - 6 JF - Current opinion in anaesthesiology JO - Curr Opin Anaesthesiol VL - 22 IS - 3 N2 - PURPOSE OF REVIEW: We describe the different possible anaesthetic techniques for an emergency caesarean section. To choose the right method of anaesthesia may have major implications for mother, child and all involved personnel. The major controversy is whether one have other or better alternatives or both than general anaesthesia, with a rapid sequence induction technique, when the foetus is compromised. RECENT FINDINGS: Recently published studies indicate that a top-up of a well functioning labour epidural is as fast as general anaesthesia, and that the top-up can be performed during preparation and transport. Spinal anaesthesia, when performed by skilled anaesthetists, is as fast or almost as fast as general anaesthesia with a very low failure rate. Combined spinal/epidural may have advantages, especially in high-risk cardiac patients, but is too time-consuming. General anaesthesia still seems to be the method of choice for most anaesthetists in extremely urgent settings. The major disadvantage with general anaesthesia is the risk of failure and the dramatic consequences of a 'cannot intubate, cannot ventilate' situation. Awareness is another concern, and the incidence varies from 0.26 to 1% in recent literature. SUMMARY: Regional anaesthesia techniques such as a single-shot spinal or a top-up of a well functioning labour epidural analgesia are good alternatives to general anaesthesia in an emergency caesarean setting. SN - 1473-6500 UR - https://www.unboundmedicine.com/medline/citation/19434772/Anaesthesia_for_urgent__grade_1__caesarean_section_ L2 - http://dx.doi.org/10.1097/aco.0b013e3283294c37 DB - PRIME DP - Unbound Medicine ER -