Current issues in general anesthesia for Cesarean section*

Marcel Vercauteren
University Hospital Antwerp, Belgium

Abstract

Mortality related to general obstetric anesthesia has not decreased during the last decade but this is probably more related to the indication for general anesthesia (emergency, concomitant pathology, …) than to general anesthesia itself. Oxygenation and airway problems remain important reasons for maternal and/or neonatal damage.
Based on recent data of maternal mortality risk and studies performed with alternative drugs, combinations and equipment avoiding succinylcholine, the use of rocuronium in a dose of 600µg/kg may be defended for rapid intubation. However its duration of action is a major drawback for a procedure as short as a Cesarean section in most hospitals. The future will determine the value of cyclodextrin encapsulation to antagonize long acting neuromuscular blocking agents.
The laryngeal mask (and subsequent modifications) have been used in cases where difficult airway was encountered or anticipated but it is premature to recommend its routine use. With respect to the choice of other induction and maintenance agents, thiopental may be replaced by either propofol or ketamine. The new volatile anesthetics seem to be safe in terms of uterine contractility. Opioids especially remifentanil, can be used in situations requiring stable hemodynamics. Further research is required to determine the possible harm of oxygen and whether this is really problematic for uncomplicated pregnancies.
Finally, all cases presenting for Cesarean section under general anesthesia should be judged on an individual basis after having provided sufficient information to the patient and after discussion with all treating physicians.

Key words: anaesthesia, general, obstetrics, Cesarean

ACTUALIZĂRI

Jurnalul Român de Anestezie Terapie Intensivă 2005 Vol.12 Nr.2, 147-152