Tidsskr Nor Laegeforen. 2010 Apr 8;130(7):748-51.

[Anaesthesia for Caesarean section]
[Article in Norwegian]

Bjørnestad E, Rosseland LA.

Kirurgisk serviceklinikk, Haukeland universitetssykehus, 5021 Bergen, Norway. elin.bjornestad@helse-bergen.no

Abstract
BACKGROUND: Regional anaesthesia (epidural or spinal anaesthesia) is increasingly used for elective and emergency caesarean sections and is considered to be safer for the mother than general anaesthesia. We present some factors that are important to consider when choosing the anaesthetic method for caesarean section.

MATERIAL AND METHODS: The article is based on obstetric anaesthesia textbooks, non-systematic searches in PubMed and own clinical experience.

RESULTS: When regional anaesthesia is correctly administrated the foetus/neonate and mother are not much affected, adverse effects are very rare and it is possible to establish contact between the mother and newborn immediately after delivery. Spinal anaesthesia is most common. Epidural anaesthesia is most often used in emergency situations when caesarean section has to be performed instead of the expected vaginal delivery and the women has already been given an epidural. Prophylactic epidural access may be prepared during delivery in women with a high risk of complications in general anaesthesia. Combined spinal and epidural anaesthesia is also an option. The most common side effect with regional anaesthesia is hypotension. Recommended preventive measures for hypotension are to cohydrate patients when inducing anaesthesia, to administer small doses of phenylephrine intravenously and to wrap the woman's legs with elastic bandages. There are few contraindications to regional anaesthesia. Women using low-molecular heparin in therapeutic doses or have massive bleeding are not suitable for regional anaesthesia.

INTERPRETATION: There are few adverse effects of regional anaesthesia in caesarean section except for hypotension that can be easily treated.