General anaesthesia for Caesarean section

Abstract

Recent work has indicated that epidural analgesia for elective Caesarean section offers distinct advantages for the neonate over general anaesthesia. ’ This work found that the incidence of significant neonatal depression was much higher in those whose mothers had received general anaesthesia, but that there were no differences in umbilical arterial pH between the two techniques, thus suggesting that general anaesthesia rather than asphyxia or aortocaval compression is responsible for most of the depressed infants born by Caesarean section. These findings, coupled to the fact that most anaesthetic related maternal mortality is associated with general anaesthesia, has resulted in a marked increase in regional techniques for Caesarean section. Nevertheless, there will always be a place for general anaesthesia in those instances where regional procedures are contraindicated or the mother refuses. Exact figures are not available for the use of the two methods in the UK, but a survey in the USA has shown that 41% of Caesarean sections are performed under general anaesthesia? The modern technique of general anaesthesia consists of intravenous induction, tracheal intubation following suxamethonium, and maintenance of a light level of anaesthesia and was described in 1959.3 Sellick’s manoeuvre4 was added in 1961. The principles of general anaesthesia for Caesarean section were laid down in 1974’ and are divided into three main areas, namely maternal requirements, neonatal requirements and obstetrician’s requirements.