General Anaesthesia For Caesarean Section Research Articles

The Study of Preoxygenation on the Maternal and Neonatal Arterial Blood Gas Analysis in General Anesthesia for Cesarean Section

The Study of Preoxygenation on the Maternal and Neonatal Arterial Blood Gas Analysis in General Anesthesia for Cesarean Section

Préoxygénation avant induction pour césarienne

In pregnant women at term, the oxygen reserve is decreased while the oxygen consumption is increased, carrying the risk of hypoxaemia during periods of apnea. Moreover, intubation of the trachea can be difficult. Therefore preoxygenation is of particular importance. The conventional method of preoxygenation consists in a 3–5 min breathing of 100 % O 2. However, in some obstetric emergencies, there may not be an adequate delay of time available for this technique. Recently, 4 maximally deep inspirations were demonstrated to be as effective as a 5-min inhalation of 100 % O 2 for preoxygenation. To determine whether these two techniques were equivalent before induction of a general anaesthesia for Caesarean section, 27 pregnant women at term (ASA 1 or 2) were studied. Following premedication with atropin sulfate (0.5 mg), the patients were randomly allocated into two groups. Group A (n = 12) was denitrogenated with 100 % O 2 for 4 min and group B (n = 15) with 4 maximally deep inspirations of 100 % O 2 within 30 s. Oxygen was administred at a flow rate of 10 L · min −1 via a non rebreathing anaesthesia system and a tight fitting face mask. Arterial saturation was assessed by pulse oximetry. General anaesthesia was induced with thiopentone (7 mg · kg −1) and succinylcholine (1.5 mg · kg −1). The trachea was intubated without previous ventilation and the delay required for the SpO 2 to decrease to 93 % was measured. This time was 137.9 ± 79.2 s (extremes 85–320) in group A and 144.5 ± 57.3 s (extremes 60–285) in group B respectively. These times were not significantly different. Apgar scores at 5 min were equivalent. These results show that pregnant women are at increased risk of developing hypoxaemia in apneic conditions and that either 4 min of O 2 breathing or 4 deep O 2 breaths are equivalent for preoxygenation prior to rapid sequence induction of general anaesthesia for Caesarean section.

Regional versus general anaesthesia for Caesarean section

Regional versus general anaesthesia for Caesarean section

Adequacy of general anesthesia for cesarean section.

To assess the adequacy of the general anesthesia commonly employed for Cesarean section, we used isolated forearm technique to study 30 parturients (physical status ASA I/II, aged 17-35 yr) scheduled for nonemergent abdominal delivery. Anesthesia was induced with intravenous thiopental (3 mg/kg, 250 mg maximum) and succinylcholine (1.5 mg/kg), and then proceeded with a mixture of 50% N2O, 50% O2, and 0.5% halothane at a flow of 5 L/min and end-tidal CO2 at 40 mm Hg. Paralysis was maintained with a 0.1% succinylcholine infusion. When eyelash reflex disappeared, patients received taped instruction via headphones at 1-min intervals for 10 min. The tapes instructed patients to flex fingers if they were able to hear, to make a fist or squeeze the investigator's hand if they felt pain, to remember six target words, and to respond with specific physical signals during later interviews. Three sets of tapes assigned at random were used in the study. For signs of inadequate anesthesia, other variables such as eye centering, pupil size, sweating, and lacrimation were concomitantly monitored at the time of induction, laryngoscopy/intubation, and skin incision, and then at 1-min intervals for 10 min. Brain activity was also monitored by means of computerized aperiodic analysis of electroencephalogram Lifescan). Patients were interviewed in the postanesthesia recovery room and again 24 h later. At the time of skin incision, 96.7% of patients (29/30) signaled awareness by flexing fingers, 86.7% (26/30) exhibited lacrimation, and 80% (24/30) made a fist or squeezed the investigator's hand, indicating pain perception.(ABSTRACT TRUNCATED AT 250 WORDS)

General anesthesia for cesarean section in a parturient with a single ventricle and pulmonary atresia

The successful management of a cesarean section in a parturient with a single ventricle and pulmonary atresia using general anesthesia is discussed. After cyanosis at birth, the patient underwent cardiac catheterization, which showed an apparent severe tetralogy of Fallot, atresia of the main pulmonary artery (PA), and a large patent ductus arteriosus. When she was 7 months of age, a Blalock-Taussig shunt (right subclavian artery to right PA) was done. She remained stable until age 11, when cyanosis increased and exercise tolerance decreased. Recatheterization more clearly defined the lesion: closed shunt, pulmonary valvular atresia, severe ductal stenosis, reduced pulmonary flow, double-outlet right

Delayed onset of coagulopathy following amniotic fluid embolism: two case reports

Two cases of amniotic fluid embolism with markedly similar clinical presentations occurred in the same unit in a 6 month period. Both patients were under general anaesthesia for caesarean section at the time of embolism. Having been successfully extubated and found to be haemodynamically stable, they developed a coagulopathy after an interval of 2 hours. There had been initial uncertainty as to the diagnosis in the first patient and the haematological sequelae were not fully anticipated. Experience in dealing with the first patient who died, may have influenced the survival of the second. The diagnosis of amniotic fluid embolism should be considered at an early stage in all cases of maternal collapse and the appropriate preparations made to combat a potential coagulopathy.

The management of anaesthesia for Caesarean section in a patient with paroxysmal ventricular tachycardia

We describe the successful management of general anaesthesia for Caesarean section in a patient with poorly controlled paroxysmal ventricular tachycardia of pregnancy. The use of alfentanil before laryngoscopy and tracheal extubation ensured cardiostability without compromising maternal or fetal wellbeing. General anaesthesia allows prompt cardioversion. We believe that in the presence of a life-threatening unstable cardiac rhythm this consideration outweighs any theoretical advantage of regional blockade.

General anesthesia for cesarean section in a parturient with quintuplet pregnancy.

General anesthesia for cesarean section in a parturient with quintuplet pregnancy.

Only maternal, not fetal, survival should persuade the anaesthetist to proceed with general anaesthesia for caesarean section after failed intubation

Only maternal, not fetal, survival should persuade the anaesthetist to proceed with general anaesthesia for caesarean section after failed intubation

Only maternal, not fetal, survival should persuade the anaesthetist to proceed with general anaesthesia for caesarean section after failed intubation

Only maternal, not fetal, survival should persuade the anaesthetist to proceed with general anaesthesia for caesarean section after failed intubation

A Comparison of Lumbar Epidural Anesthesia Using Bupivacaine-Fentanyl-Epinephrine-Sodium Bicarbonate Mixture with General Anesthesia for Cesarean Section

A Comparison of Lumbar Epidural Anesthesia Using Bupivacaine-Fentanyl-Epinephrine-Sodium Bicarbonate Mixture with General Anesthesia for Cesarean Section

General anaesthesia for Caesarean section

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.

A Comparison of Neonatal Apgar Score Following Regional or General Anaesthesia for Caesarean Section

A Comparison of Neonatal Apgar Score Following Regional or General Anaesthesia for Caesarean Section

Recall Following N2O-O2-Fentanyl General Anesthesia for Cesarean Section

Recall Following N2O-O2-Fentanyl General Anesthesia for Cesarean Section

Relationship between Arterial and End-tidal Carbon Dioxide Tension during General Anesthesia for Caesarean Section

Relationship between Arterial and End-tidal Carbon Dioxide Tension during General Anesthesia for Caesarean Section

Awareness during Caesarean section

Between 1982 and 1989 over 3000 patients were questioned about recall and dreaming after general anaesthesia for Caesarean section. Some 28 (0.9%) patients were able to recall something of their operation and 189 (6.1%) reported dreams. There was uniform adherence to a rigid anaesthetic protocol up to and including 1985, but a much publicized incident reported from the courtroom stimulated a relaxation of this regimen. Consequently the incidence of awareness decreased from 1.3% to 0.4%, and the incidence of dreaming was also reduced. Recollections of surgery were confined to manipulations, noises and voices. None of our patients complained of pain at the time of interview, although one since has. The inadequacies of the initial protocol and an approach to informed consent are discussed.

ISOFLURANE WITH EITHER 100% OXYGEN OR 50% NITROUS OXIDE IN OXYGEN FOR CAESAREAN SECTION

Two hundred mothers undergoing general anaesthesia for Caesarean section were allocated randomly to receive either 100% oxygen (group 100) or 50% nitrous oxide in oxygen (group 50), both supplemented with isoflurane. In each group the concentrations of isoflurane were chosen to deliver 1.5 MAC for the first 5 min after induction and 1.0 MAC thereafter. The mean umbilical venous PO2 was greater in group 100 for emergency sections (P = 0.001). Babies born to mothers in group 100 required less resuscitation than those in group 50 (P = 0.04) and there was a tendency to higher Apgar scores at 1 min in group 100, although this was not statistically significant. There were no instances of awareness, although two patients in group 100 and three in group 50 reported dreaming. This study confirms earlier findings that the use of 100% oxygen can significantly improve fetal oxygenation during Caesarean section, with particular benefit in emergency cases. This is associated with a lower incidence of neonatal resuscitation.

Inspired Oxygen Concentration During General Anesthesia for Caesarean Section

Inspired Oxygen Concentration During General Anesthesia for Caesarean Section

Epidural or general anaesthesia for Caesarean section?

Epidural or general anaesthesia for Caesarean section?

Detecting awareness during general anaesthetic Caesarean section An evaluation of two methods

Seventy-four patients received general anaesthesia for Caesarean section. Seven percent of the elective group and 28% of the emergency patients reported dreaming or recall of voices during the procedure (p less than 0.05) at postoperative interview. One patient from each group reported feeling pain or suffocation. All patients were monitored for awareness using the isolated forearm technique and lower oesophageal contractility. Provoked lower oesophageal contractility was the most effective of the different indices. A value greater than 35 mmHg on at least one occasion had a false negative rate of 33%, a false positive rate of 28% and a predictive value of 25%. A value greater than 13 mmHg picked up all patients who dreamed, with a false positive rate of 68%. Both of the 'aware' patients had provoked lower oesophageal contractility response of greater than 70 mmHg, an attribute shared by only 8% of the rest. The isolated forearm was particularly ineffective.