Anaesthetic Technique For Caesarean Section Research Articles

A Five-Year Retrospective Closed Cohort Study to Find a Superior Anaesthetic Technique for Caesarean Section From a Haemodynamic Perspective.

Background A cesarean section (CS) is common and requires a safe and effective anesthetic technique for the safety of both the mother and the fetus. This study aims to compare the intraoperative hemodynamic safety profile with general anesthesia (GA) and regional anesthesia (RA) and propose a superior technique for cesarean from the hemodynamic perspective. Methods After obtaining ethical committee approval, a retrospective closed cohort study was conducted on patients who underwent cesarean with GA and RA. This study was conducted at a tertiary-level university hospital in Oman from January 2015 to December 2019. The investigators collected maternal and fetal data (hypotension, bradycardia, blood loss, APGAR score, fetal mortality, complications, and length of stay) from January 2015 to December 2019. The primaryoutcome was the incidence of intraoperative hypotension, and the secondaryoutcomes studied were significant blood loss and APGAR score in both anesthesia techniques. Results A total of 2500 cesarean patients were studied, of whom 1379 received RA and 1121 received GA. The overall hypotension (systolic BP<90 mm Hg) rate observed was 40.1%; it was significantly lower with GA as compared to RA (32.1% versus 46.5%, respectively, P<0.001, OR 0.545, 95% CI 0.462 to 0.643). Consequently, the requirement for vasopressors was low with GA compared to RA (1.6% versus 23.1%, P<0.001, OR 0.054, 95% CI 0.034 to 0.088). Blood loss (>1 L) was remarkably higher in GA as compared to the RA (15.5% versus 8.9%, respectively, P<0.001, OR 1.916, 95% CI 1.499 to 2.448). APGAR scores were lower with GA than RA (2.8% versus 0.9%, P<0.001). Bradycardia and fetal mortality were almost equal in both groups. Conclusion GA is associated with significantly better hemodynamic stability during the cesarean section.

Post-spinal hypotension management for cesarean section in low resource settings: efficiency and safety of two very low-dose boluses of norepinephrine, a randomized double-blinded controlled trial

Spinal anesthesia is the gold standard anesthetic technique for cesarean section. However, its major complication is hypotension. Norepinephrine has recently been described as an efficient and safe alternative to Phenylephrine. The aim of this study was to determine the effective target bolus of Norepinephrine to prevent and treat post-spinal anesthesia hypotension. We conducted a prospective controlled randomized study including 126 parturients scheduled for cesarean delivery under spinal anesthesia. We compared two groups that received a prophylactic bolus of either 1μg/kg or 0.5μg/kg of Norepinephrine without fluid loading. The rescue intravenous bolus of Norepinephrine was half the dose of the prophylactic bolus. The main outcomes were the percentage of decrease in systolic and mean blood pressure. The secondary outcomes included the timing of the first hypotension, duration of hypotension, number of rescue boluses, total Norepinephrine consumption, incidence of hypotension and maternal adverse effects and fetal outcomes. Our primary outcome has shown similarities between groups; delta systolic blood pressure before delivery was 19.4% in group 1µg/kg versus 20.5% in group 0.5µg/kg. Both groups were similar for all secondary outcomes, except that the higher dose of Norepinephrine resulted in more hypertension. Fetal outcomes were similar in both groups. Bolus of 0.5μg/kg followed by rescue doses of 0.25μg/kg of Norepinephrine was efficient in preventing and treating spinal anesthesia-induced hypotension. These doses may be recommended for routine use in healthy parturients.

The Comparison between Spinal Anesthesia Bupivacaine and Sevoflurane Anesthesia for Cesarean Section on Apgar Score

The use of the anesthetic technique for cesarean section is still debatable because of the side effects caused by anesthesia for mothers and neonates. The succeed to determine anesthetic technique can be seen from the outcome of the final condition of the mother and the neonates. The assessment of the succeed to determine anesthetic technique in neonates has been using the Apgar score by assessing the clinical status of the newborn in the first and fifth minutes. This research is aimed to understand the comparison between Apgar scores in cesarean section using general anesthesia sevoflurane and spinal anesthesia bupivacaine. This research is analytical retrospective with a cross-sectional study approach, using a total sample of 40 patients who performed cesarean section from August to November 2021, the samples were taken by consecutive sampling. The data was taken from the medical records of the Melinda Mother and Child Hospital, Bandung. The results of this research showed that there was no significant difference in the APGAR Score first minute between general anesthesia and spinal anesthesia (p=0,054) in the fifth minute (p=0,708). There was no effect on APGAR scores in the general anesthesia sevoflurane group and spinal anesthesia bupivacaine group, and both anesthetic groups had a good effect on neonates

THE EFFECT OF ONDANSETRON ADMINISTRATION 20 MINUTES PRIOR TO SPINALANAESTHESIA ON HAEMODYNAMIC STATUS IN PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION: COMPARISON BETWEEN TWO DIFFERENT DOSES

Background: Risks involved in general anaesthesia has made spinal anaesthesia the standard anaesthetic technique for caesarean section. Spinal anaesthesia has its own side effects that may affect the mother and the unborn child's wellbeing. Ondansetron is a 5-HTreceptors antagonist, basically used as an antiemetic drug and is thought to counteract bradycardia and hypotension induced by spinal block. The primary aim of the study was to assess systolic blood pressure (SBP), diastolic blood pressure (DBP), and the mean arterial pressure (MAP) among different ondansetron doses and a control group in different time intervals. Methods:Aprospective, double-blinded, placebo- controlled, randomized clinical trial was conducted during a period of 6 months on a total of 90 patients, scheduled to undergo elective caesarean delivery under spinal anesthesia, in SMGS Hospital, Jammu. All patients with ASAI and II parturient, who were included in the study. Results: Number of patients with hypotension, was not signicantly different between the study groups. Total number of hypotensive episodes showed signicant difference and was lower in Group 2. (p=0.044) Patients of group 1 had increased frequency of administration of mephtermine in response to fall in blood pressure.In Ondansetron group, there was a dose dependant decrease in ephedrine requirement. Conclusion: Administering ondansetron (6 mg) 20 minutes before spinal block can raise the hope of increasing the efcacy of Spinal anesthesia. It may not cause reduction in the incidence of hypotension in caesarean section under spinal block, but can signicantly decrease the consumption of adrenergic agonists.

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.

FOOT DROP AFTER SPINAL ANAESTHESIA FOLLOWING EMERGENCY APPENDECTOMY

Spinal anesthesia is the preferred anesthetic technique for cesarean section. Neurological complications are very rare and often transient after spinal anesthesia. A 11-year old male child present with pain abdomen in emergency department and underwent emergency appendectomy on 12-07-2019. During operation spinal anesthesia was induced. On 15-07-2019 patients was discharged from hospital. Patient revisited Neurology OPD with complaints of Foot Drop on 31-07-2019. Patient investigated with MRI and Nerve Conduction Studies. On MRI was found diffuse disc bulge at L3, L4, L5 level causing bilateral neural foramina narrowing and in nerve conduction study was found neuropathy of left peroneal and sural nerves. Patient was treated conservatively. Foot drop is a neurological disorder, which occurs following natural childbirth and spinal anesthesia due to direct needle trauma or local anesthetic toxicity. This complication is transient and usually resolves within a few days

P.38 Impact of COVID-19 pandemic on anaesthetic technique for caesarean section

Introduction: COVID-19 is an international public health emergency leading to dramatic shifts in health care. The main challenges for obstetric anaesthesia have been rapidly changing theatre pathways, measures implemented to prevent spread of infection and use of personal protective equipment (PPE).1 We investigated how the pandemic and resulting measures influenced the choice of anaesthetic technique for caesarean section (CS) and compared practice to RCOA standards and pre-COVID performance at the University Hospitals of Leicester (UHL).

The Value of Magnesium Sulfate in the Pre-Hospital Phase of the Management of Eclampsia

Eclampsia is a very serious complication of pregnancy, its occurrence is responsible of maternal and fetal morbidity and mortality. The aim of this study is to clarify the value of Magnesium Sulfate in the prevention of convulsive state and in the choice of anesthetic technique for cesarean section during eclampsia. We realized a prospective descriptive, analytical and comparative study over a period of 5 months, concerning a series of 49 pregnant women admitted to the anesthesia-intensive care unit of the Souissi Maternity Hospital in Rabat, with eclampsia. The diagnosis of eclampsia was made due to the occurrence of convulsive seizure (s) linked to pregnancy-induced hypertension. It was found that eclampsia mainly affected young women (age less than or equal to 25 years) with a percentage of 57.3%. The majority of patients were first-time mothers (55.1%). This condition manifests itself most often in the last trimester of pregnancy (72.9%), especially in pre-partum. The majority of patients did not receive an antenatal consultation. The treatment of choice in our study was magnesium sulfate. So, 51% of patients had not received magnesium sulfate before their admission to our hospital and 56% of them had had more than one seizure. And the 49% of patients, on the other hand, had received magnesium sulfate and only 18% of them had had the seizure again. Our obstetric attitude was based on immediate delivery with a caesarean section. 34.5% cesarean sections were performed under general anesthesia, compared with 65.5% under spinal anesthesia. The fetus morbidity was mainly represented by prematurity (30.6%) and neonatal distress (28.5%). The prognosis of eclampsia remains bleak both for the mother with a maternal mortality rate of 4%, and for the fetus with a perinatal mortality rate of 16.3%.

Comparison of the effects of lateral and sitting position during induction of spinal anaesthesia with plain levobupivacaine in caesarean section

Introduction: Spinal anaesthesia is a commonly employed anaesthetic technique for caesarean section. Levobupivacaineis a new long acting amide, local anaesthetic. Only few studies have investigated spinal anaesthesia using plain levobupivacaine in obstetrics.Levobupivacaine has all the desirable qualities of local anesthetics like with rapid onset, wide margin of safety, adequate surgical anaesthesiawith minimal side effects on the mother as well fetus. Aim and Objectives: To study the effects of spinal anaesthesia induced in lateral and sitting position during caesarean section using plain levobupivacaine. Materials and Methods: The study was carried out in tertiary care centre between Jan. 2014-June 2015 on total 100 patients posted for caesarean section. The parameters observed included- Sensory blockades onset and its duration, motor blockades onset, duration and degreeand quality of anaesthesia. Results: In group L (that received plain levobupivacainein left lateral position) 90% of patients had onset to T10 in 3-4 minutes. Onset of sensory block in group L was in 3.62±0.09 minutes and 3.77±0.11 minutes in group S (those received plain levobupivacainein sitting position). Two dermatome regression in group L were 80.96 ± 1.75 min and in group S were 81.44 ± 1.70 minutes. Motor onset in group L and S was 5.747 ± 0.375 minutes and 5.876 ± 0.396 min respectively. Total duration of motor block in group L was 157.90 ± 3.23 minutes. Conclusion: We concluded that 12.5mg dose of isobaric levobupivacaine 0.5% provides effective spinal anaesthesia, ensures haemodynamic stability, excellent quality of sensory and motor block with no influence of gravity on the spread in sitting as well as lateral position. Keywords: Caeserrian, Lateral, Levobupivacaine, Spinal.

A comparison of time to achieve T5 blockade in lateral versus sitting position during elective cesarean section under spinal anesthesia: A randomized control trial

Context: Spinal anesthesia is the preferred anesthetic technique for cesarean section. Lateral and sitting positions are commonly used for performing subarachnoid block in parturients. Maternal positioning affects the spread of local anesthetic drugs and affects the onset and level of block. Faster onset of block is associated with hemodynamic changes having detrimental effects in parturients. Aims: The aim of our study is to evaluate the effectiveness of two maternal positions – lateral and sitting. Materials and Methods: This prospective randomized control study was conducted on 100 parturients undergoing elective cesarean section under spinal anesthesia. They were randomly assigned into two groups. Group L received spinal anesthesia in lateral and group S in sitting position. Time to achieve T5 blockade, hemodynamics, motor blockade, fetal pH, and Apgar score were noted. Independent sample 't' test, Chi-square test, and paired t test were used for statistical analysis. Results: Time to achieve T5 dermatomal level was less in group L which was statistically significant (2.60 ± 0.535 vs. 4.34 ± 0.745 min, P < 0.001). Number of attempts required and time taken for giving spinal was significantly more in group L. The drop in mean arterial pressure and requirement of phenylephrine was more in lateral position. Conclusion: Adoption of sitting position while performing subarachnoid block for cesarean section was found to be superior to lateral position in view of better hemodynamic stability, need for fewer attempts, and better maternal comfort, though time to achieve T5 block was longer.

Caesarean section for placenta praevia: A retrospective study of anaesthetic technique and foeto-maternal

Introduction: Placenta praevia complicates approximately 0.3-0.8% of pregnancies in multiparous parturient and there is an increased risk in those with previous Caesarean section. The choice of anaesthetic technique usually poses dilemma to the attending anaesthetist. The aim of this study was to review the choice of anaesthetic technique for caesarean section complicated by placenta praevia and determine foeto-maternal outcome.Patients and Methods: This was a retrospective survey covering a period of four years (January 2013 - December 2016). After Ethics Committee approval, information was obtained from the anaesthetic and theatre records and the patients’ case notes. The information obtained were: patients’ characteristics, obstetric history, grade of placenta praevia, indications for surgery, choice of anaesthetic technique, PCV/haemoglobin level, haemodynamic changes, blood transfusion, maternal and foetal outcome. The data were analysed using IBM SPSS version 20.Results: A total of 4,388 Caesarean sections were carried out during the 4- year period of review. One hundred and forty-five cases (3.3%) with different degrees of placenta praevia progressing to Caesarean section were identified. The mean age (years) was 32.6+5.3 with a mean gestational age(weeks) of 36.7±1.11. Thirty-nine (26.9%) patients were offered general anaesthesia while 106 (73.1%) were done under spinal anaesthesia. The mean blood loss in the GA and spinal group was 1,080 + 970.53 and 753.77 + 568.19 ml respectively (P = 0.0135). 87.6% neonates were delivered alive. Seventy-nine (54.5%) were elective procedure with adequate preparation. There were two (1.4%) cases of maternal mortality and perinatal mortality of 12.4%.Conclusion: The anaesthetic technique for patients with placenta praevia should be determined by the patient’s haemodynamic status and the grade of the placenta praevia.

Anaesthetic management of a patient diagnosed with amyotrophic lateral sclerosis taken to caesarean section: Case report

IntroductionIn the obstetric population with amyotrophic lateral sclerosis, caesarean delivery may be indicated in order to avoid greater maternal respiratory distress induced by the physiologic changes at the end of gestation and the progressive muscle weakness caused by the disease. Optimal anaesthetic management is required in order to guarantee the ideal conditions for surgery and to preserve patient respiratory function. ObjectiveTo describe the anaesthetic management of a patient diagnosed with amyotrophic lateral sclerosis scheduled for caesarean section. Methods and resultsWe describe the case of a 38-week pregnant woman diagnosed with amyotrophic lateral sclerosis who underwent caesarean section under sequential combined spinal-epidural anaesthesia. In addition, a review of the literature was conducted. ConclusionsCombined spinal-epidural anaesthesia was a good option as anaesthetic technique for caesarean section in this patient with amyotrophic lateral sclerosis.

Regional Block versus General Anaesthesia for Caesarean Section and Neonatal Outcomes. A Clinical Comparative Study

Introduction: Anaesthesia for caesarean section poses one of the most critical of all problems to the anaesthesiologist. Aim of the present study was to find out an anaesthetic technique for caesarean section in which the babies are delivered in better clinical condition employing Apgar scoring system. Patients and Methods: In the study 180 patients undergoing caesarean section were divided randomly into 3 groups consisting of 60 patients each according to the indication for caesarean section. . Group1: elective post caesarean section. Group 2: failure to progress (urgent section). Group 3: fetal distress (emergency section). In each group 30 patients were given regional block and 30 patients were given general anesthesia. Results: At one minute when the Apgar score was compared for neonatal depression ( Apgar score 0.05) found in group 1 but in group 2 and 3 the difference was significant (P 0.05) between both the techniques in all the three groups. Conclusions: Both general anaesthesia and regional block appear equally safe for babies delivered by elective caesarean section but in unplanned cases regional block provides fetal advantages

Epidural anesthesia: A safe option for cesarean section in parturient with severe pulmonary hypertension

Rheumatic heart disease is the most common cardiac disease complicating pregnancy in developing countries. Heart disease accounts for 15% pregnancy-related mortality. In the presence of maternal heart disease, the circulatory changes of pregnancy may result in exacerbation of the hemodynamic perturbations due to complex cardiac valvular lesions leading to decompensation or death of mother or fetus. Determining the ideal anesthetic technique for cesarean section in the presence of complex cardiac conditions remains a much debated topic. General anesthesia is associated with a further increase in pulmonary pressure in response to laryngoscopy and intubation along with myocardial depression by anesthetic agents. Neuraxial blockade may lead to decrease in systemic vascular resistance and cardiac output. We report the successful anesthetic management of a parturient suffering from rheumatic heart disease with multivalvular lesions resulting in severe pulmonary hypertension under epidural anesthesia with good maternal and neonatal outcome. Successful management requires vigilant perioperative monitoring and thorough knowledge of the hemodynamics of complex cardiac valvular disease.

Safety of subarachnoid block for elective cesarean delivery in women with major degree placenta previa

Background: Placenta previa is a serious complication of pregnancy, often causing antepartum hemorrhage with significant fetomaternal morbidity and mortality. The ideal anesthetic technique for cesarean section is controversial because of associated complications. The study aimed at ascertaining the safety of subarachnoid block among women with major degree placenta delivered by elective cesarean section. Materials and Methods: This was a prospective analysis of 11 parturients of the American Society of Anesthesiologists Class I/II with major degree placenta previa billed for elective cesarean section, who desired and consented for spinal anesthesia over a 32-month period. Spinal anesthesia was induced with 10 mg heavy bupivacaine plus 0.5 mg morphine sulfate after a 2-L infusion of normal saline. The surgeon incised the uterus only after 10 IU of intravenous oxytocin was given. Data collected included pre- and post-operative packed cell volume (PCV), mean arterial pressure (MAP), pulse rate, peripheral oxygen saturation, estimated blood loss (EBL), and Apgar scores. The data were analyzed using SPSS version 21 for Windows; with statistical significance set at P Results: The mean preoperative PCV was 33.6 ± 3.5% and pulse rate was 99.3 ± 8.5/min while MAP was 97.9 ± 9.9 mmHg. Mean EBL was 918.2 ± 499.6 ml. Apgar scores at 1 and 5 min were 8.8 ± 1.2 and 10.00, respectively. There was no statistical significance between pre- and post-operative parameters: Pulse rate 95.71 ± 14.07/min (P = 0.96), MAP 95.7 ± 12.13 (P = 0.70), and PCV 30.3 ± 3.9 (P = 0.32). Ten parturients (90.9%) had spinal hypotension. There was no maternal or fetal death. Conclusion: Subarachnoid block is safe in women undergoing cesarean delivery for major degree placenta previa, but anticipation for hypotension is important.

Combined spinal-epidural anesthesia in a mild thrombocytopenic patient with antiphospholipid antibody syndrome.

Combined spinal-epidural anesthesia in a mild thrombocytopenic patient with antiphospholipid antibody syndrome.

Urgent Caesarean section in a patient with a late presenting suspected phaeochromocytoma

SummaryWe report the anaesthetic management of a woman who presented at term with a suspected phaeochromocytoma necessitating urgent Caesarean section. Subsequent histological diagnosis confirmed diffuse adrenal medullary hyperplasia. There is little evidence or consensus regarding the optimal anaesthetic technique for caesarean section in patients with raised catecholamines. Both general [1, 2] and regional [3, 4] anaesthetic techniques have been described. We consider the benefits and drawbacks of both.

Choice of Anaesthesia for Caesarean Section Among Female Health Workers

Current trend in anaesthesia for obstetric patient is toward regional anaesthesia with less general anaesthesia, and the Royal College of Anaesthetists has proposed that 85% of emergency Caesarean section should be carried out under regional anaesthesia. It had been documented that general anaesthesia was found to be associated with 12.5% maternal mortality, while regional anaesthesia is associated with a reduction in maternal and fetal mortality and morbidity. The aim of this survey therefore is to assess the knowledge and attitude of female health workers to the use of spinal anaesthesia for Caesarean delivery. Two hundred and fifty respondents were obtained, and most of them 170 (68.0%) would prefer spinal anaesthesia for Caesarean section. It was found that spinal anaesthesia was chosen by those with higher educational status, who also were the people in the higher medical cadre. Previous experience of anaesthesia significantly affects the choice of anaesthetic technique for Caesarean section (df = 2, p= 0.019, X2= 7.939). Pre-operative counselling should aim to dispel patients' misconceptions, fears and anxieties about anaesthesia generally.Key words:Spinal anaesthesia, Choice, Caesarean section.

A randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia

Cytokines are significant mediators of the immune response to surgery and also play a role in parturition. The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha. Thirty-five parturients scheduled for elective cesarean section were randomly assigned to general (n=18) or neuraxial (n=17) anesthesia. The general anesthesia group received thiopental 4 mg/kg, succinylcholine 1-1.5 mg/kg and 1% end-tidal concentration of sevoflurane in nitrous oxide and 50% oxygen. The neuraxial anesthesia group received intrathecal 0.5% levobupivacaine 1.8-2.2 mL and epidural fentanyl 1 microg/kg. Blood samples were taken for IL-6 and TNF-alpha immediately after positioning the parturient on the operating table, after uterine incision and before the umbilical cord clamping and 24h after surgery (T(1), T(2) and T(3) respectively). The two groups did not differ in IL-6 (P=0.15) or TNF-alpha (P=0.73) serum concentrations at any time point. In the general and neuraxial anesthesia groups, IL-6 serum concentrations were significantly higher in the third blood sample, T(3) (12.2+/-5.0 and 15.2+/-4.3 pg/mL), than in T(1) (0.41+/-0.38 and 0.29+/-0.10 pg/mL) and T(2) (0.37+/-0.47 and 0.24+/-0.05) respectively (P<0.001). Within each group, serum TNF-alpha concentrations did not differ significantly over time (P=0.44). Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section. Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique.

Anaesthesia for caesarean section in a woman with lung cancer: case report and review

A 33-year-old woman pregnant with twins was diagnosed with metastatic lung cancer during pregnancy. Her multidisciplinary care raised many medical and ethical issues. To help decide on the best anaesthetic technique for caesarean section, a literature search of published case reports of pregnancy associated with lung cancer was performed. Thirty-five cases of primary lung cancer associated with pregnancy were found. Anaesthetic technique was reported in only five of the 20 patients who underwent caesarean section: one spinal, three epidurals and one general anaesthetic. Of the 11 patients who delivered vaginally, only one was reported to have received epidural analgesia. As published data regarding anaesthesia and analgesia are limited for women with lung cancer in pregnancy, we describe our perioperative approach and review the potential challenging aspects of management in a pregnant patient with metastatic lung cancer.