Anaesthesia for Caesarean section: Basic principles

2020 ◽  
pp. 273-296
Author(s):  
Rachel Collis
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Enhanced Recovery ◽  
Current Evidence ◽  
Basic Principles ◽  
Cardio Vascular ◽  
Available Information ◽  
Vasopressor Use ◽  
Obstetric Surgery ◽  
Elective Caesarean Delivery

Management of the woman for caesarean delivery requires meticulous planning and skill from the anaesthetist. The time available to plan and communicate with the woman will depend on the degree of urgency to deliver the baby. However, this chapter sets out the important basic principles which need to be adhered to, regardless of the time available. Information and consent for the planned technique is discussed, with a review of antacid prophylaxis and monitoring requirements for the woman and fetus prior to delivery. Enhanced recovery in obstetric surgery is considered the gold standard for elective caesarean delivery, with attention to the details of each aspect described. Caesarean section confers considerable cardio-vascular instability, therefore attention to maternal positioning to minimize aorto-caval compression, intravenous pre-loading, and current evidence to support the practice of differing vasopressor use is highlighted.

The efficacy of onion extract in the management of subsequent abdominal hypertrophic scar formation

2020 ◽  
Vol 29 (10) ◽  
pp. 612-616
Author(s):  
Emre Sinan Güngör ◽  
Duygu Güzel ◽  
Ali Galip Zebitay ◽  
Gülşah İlhan ◽  
Fatma Ferda Verit
Keyword(s):  
Caesarean Section ◽  
Allium Cepa ◽  
Hypertrophic Scar ◽  
Caesarean Delivery ◽  
Control Group ◽  
Surgical Removal ◽  
Study Group ◽  
Caesarean Scar ◽  
Prophylactic Use ◽  
Elective Caesarean Delivery

Objective: Development of postoperative scars is often a problem. This study aimed to evaluate the efficacy of gel containing Allium cepa extract, allantoin and heparin (Contractubex, Merz Pharmaceuticals GmbH, Frankfurt, Germany) in reducing scarring after a caesarean section by comparing it with a control group, and also intra-individually, using the Vancouver Scar Scale (VSS). Method: A total of 120 patients who underwent a second elective caesarean delivery and who presented with hypertrophic scar development after their first caesarean section were included in the study. A scar revision was performed for all patients during the second caesarean operation. Patients in the study group (n=60) were advised to apply the topical scar gel postoperatively for a period of 6 months. The control group (n=60) received no treatment. Results: Significant reductions were observed in the vascularity, pigmentation and height subgroups of the VSS for those in the group who continued the treatment to 24 weeks. An intra-individual analysis showed that the gel effectively reduced scarring after the second caesarean section. Conclusion: The prophylactic use of the gel to reduce scar development offers better results for vascularity, pigmentation and height subscales of the VSS after surgical removal of the primary caesarean scar during the second caesarean section. The results were better both intra-individually, and also in comparison with the control group and support the use of a gel containing Allium cepa extract, allantoin and heparin to reduce scarring after a caesarean section.

Anaesthesia for Caesarean section: General anaesthesia

2020 ◽  
pp. 325-354
Author(s):  
Stephen Morris ◽  
Rhidian Jones
Keyword(s):  
Caesarean Section ◽  
Difficult Airway ◽  
General Anaesthesia ◽  
Current Evidence ◽  
Failed Intubation ◽  
Airway Assessment ◽  
Obstetric Anaesthetist ◽  
Obstetric Surgery

There will always be the need to give GA to pregnant womrn, and it is paramount that the obstetric anaesthetist is well prepared to perform a GA quickly and safely. This chapter reviews the current evidence, drugs, and conduct of GA for CS, with emphasis on exemplary communication within the delivery suite team and meticulous airway assessment to identify features suggestive of additional anticipated difficulty. A helpful ‘pre-induction’ checklist illustrates the need for team-based communication in preparation and planning to mitigate against complications following induction. The latest guidelines from the Obstetric Anaesthetists' Association and Difficult Airway Society on the management of failed intubation and ventilation have been included. The chapter also includes up-to-date information on accidental awareness in obstetric surgery from NAP4, and the steps to avoid and manage aspiration if it occurs.

Effect of intrathecal fentanyl on oxytocin secretion in pregnant women not in labour

2001 ◽  
Vol 101 (4) ◽  
pp. 415-419 ◽  
Author(s):  
K.U. SHIBLI ◽  
A.R. DHILLON ◽  
J.A. GOODE ◽  
C.L. GILBERT ◽  
J.W. THOMPSON ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Spinal Anaesthesia ◽  
Caesarean Delivery ◽  
Intrathecal Injection ◽  
Intrathecal Administration ◽  
Group I ◽  
Before And After ◽  
Pooled Samples ◽  
Elective Caesarean Delivery

We studied the effects of spinal intrathecal fentanyl on oxytocin secretion in 20healthy women prior to an elective caesarean delivery at term under spinal anaesthesia. The women were randomly allocated into two groups with respect to spinal anaesthesia. Group I (n = 10) received intrathecal bupivacaine (15mg) plus fentanyl (25μg), and Group II (n = 10) received intrathecal bupivacaine (15mg) alone, prior to caesarean section. The two groups were comparable demographically. Altogether, ten samples of 4.5ml of blood (taken every 60 s) were obtained before and ten samples were obtained after the intrathecal administration of the drug and establishment of the T6 block, and plasma oxytocin concentrations were assayed for each subject. Oxytocin was measured by RIA. We found no significant differences in plasma oxytocin concentrations of individual subjects before and after intrathecal injection. In addition, there were no significant differences in plasma oxytocin concentrations between the two groups when pooled samples from the subjects were compared for the pre- and post-intrathecal injection phases. We conclude that the spinal intrathecal administration of fentanyl does not suppress oxytocin secretion in pregnant women who are not in labour at term.

scholarly journals Analgesic effects of intravenous ketamine after spinal anaesthesia for non-elective caesarean delivery: a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044168
Author(s):  
Prahlad Adhikari ◽  
Asish Subedi ◽  
Birendra Prasad Sah ◽  
Krishna Pokharel
Keyword(s):  
Postoperative Pain ◽  
Adverse Effects ◽  
Outcome Measures ◽  
Caesarean Delivery ◽  
Low Dose ◽  
Saline Group ◽  
Secondary Outcome ◽  
Pain Scores ◽  
Intravenous Ketamine ◽  
Elective Caesarean Delivery

ObjectivesThis study aimed to determine if low dose intravenous ketamine is effective in reducing opioid use and pain after non-elective caesarean delivery.DesignProspective, randomised, double-blind.SettingTertiary hospital, Bisheshwar Prasad Koirala Institute of Health Sciences, Dharan, NepalParticipants80 patients undergoing non-elective caesarean section with spinal anaesthesia.InterventionsPatients were allocated in 1:1 ratio to receive either intravenous ketamine 0.25 mg/kg or normal saline before the skin incision.Primary and secondary outcome measuresThe primary outcome was the total amount of morphine equivalents needed up to postoperative 24 hours. Secondary outcome measures were postoperative pain scores, time to the first perception of pain, maternal adverse effects (nausea, vomiting, hypotension, shivering, diplopia, nystagmus, hallucination) and neonatal Apgar score at 1 and 5 min, neonatal respiratory depression and neonatal intensive-care referral.ResultsThe median (range) cumulative morphine consumption during the first 24 hours of surgery was 0 (0–4.67) mg in ketamine group and 1 (0–6) mg in saline group (p=0.003). The median (range) time to the first perception of pain was 6 (1–12) hours and 2 (0.5–6) hours in ketamine and saline group, respectively (p<0.001). A significant reduction in postoperative pain scores was observed only at 2 hours and 6 hours in the ketamine group compared with placebo group (p<0.05). Maternal adverse effects and neonatal outcomes were comparable between the two groups.ConclusionsIntravenous administration of low dose ketamine before surgical incision significantly reduced the opioid requirement in the first 24 hours in patients undergoing non-elective caesarean delivery.Trial registration numberNCT03450499.

STUDY OF OBSTETRIC OUTCOMES IN ELECTIVE AND EMERGENCY CAESAREAN SECTION IN PATIENTS WITH PRIOR LOWER SEGMENT CAESAREAN SECTION

2021 ◽  
pp. 57-60
Author(s):  
Dipak S. Kolate ◽  
Meenal M. Patvekar ◽  
Shriraj Katakdhond ◽  
Yogesh Thawal ◽  
Kale DhanaLaxmi ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Caesarean Delivery ◽  
Emergency Caesarean Section ◽  
Obstetric Outcomes ◽  
Fetal Outcomes ◽  
Emergency Caesarean ◽  
Management Protocol ◽  
History Of

Background:Acomprehensive study of maternal morbidity and mortality with perinatal outcome in patients with prior LSCS undergoing elective or emergency caesarean section was carried out. With the sky rocketing caesarean section rates worldwide an increasing number of women face the issue of mode of delivery in their current pregnancy. There are conicting reports regarding the safety of a trial for vaginal birth after caesarean delivery (VBAC) in terms of uterine rupture, maternal and perinatal morbidity. The purpose of this study was to evaluate the obstetric and fetal outcomes of patients presenting at term with a history of previous one or more LSCS. Methods:Asix months prospective, observational study was conducted where all patients who had a term pregnancy with a history of previous one or more LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients with elective or emergency LSCS in the present pregnancy were noted and tabulated. Adescriptive analysis of these outcomes was carried out. Results: 100 Patients at term, with a history of previous one or more LSCS were studied. 38 patients underwent an elective repeat caesarean delivery and 62 in emergency.Scar dehiscence was seen in 35.5 % of the patients who were presented in emergency with uterine contractions or lower abdominal pain and those were not candidate for a trial for VBAC.All of the complications were signicantly higher in emergency group in terms of both maternal (83.9 % Vs 31.6%) and perinatal outcome (6.5% Vs 0 %). Conclusion:With an increase in the proportion of patients with a history of previous LSCS, it is essential for health care institutions to have proper antenatal counseling regarding plan of delivery and vigilance while operating patients with prior history of LSCS , especially in emergency situation. There should be a well dened management protocol in an effort to decrease the number of complications and bring down the overall maternal morbidity & mortality .

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