General Anesthesia for C-section vs Partial Anesthesia

Pregnancy and birth: Cesarean sections: What are the pros and cons of regional and general anesthetics?

Different risks:

In general anesthesia, there is a risk of the woman vomiting while unconscious and the vomit getting into her lungs (called aspiration of stomach contents). Although this is very rare, it can be life-threatening. Women who have an epidural or a spinal block occasionally experience a sudden major drop in blood pressure. They might also have a type of headache that can be caused by the injection into the epidural or subarachnoid space (“post-dural puncture headache”).

Research results:

There weren’t enough women in the different studies to be able to say whether general anesthetics are more likely to lead to serious complications like aspiration of stomach contents. This complication was generally rare. But the studies were big enough to find out what side effects are likely to be most common in babies. These include things like breathing problems. There were no major differences between the various types of anesthetics here.

Anesthesia for cesarean delivery: general or regional anesthesia—a systematic review

Background

The rate of cesarean delivery in the USA is reported to be around 30% of all live births and 25–30% in Columbia (Páez and Navarro 2012). Also, it has been reported by Little et al. (Little et al. 2016) that the USA has a higher rate of cesarean delivery around 65%. Regional anesthesia especially spinal anesthesia has been favored as the best choice for elective uncomplicated cesarean delivery due to its avoidance of the airway, less risk of aspiration of gastric content, and easy to perform (Shibli and Russell 2000; Kim et al. 2019). Regional anesthesia is safe and effective, but it does have complications such as hypotension, local anesthetic toxicity, post-dural puncture headache (PDPH), and nerve damage (Bakri et al. 2015; Bloom et al. 2005; Afolabi and Lesi 2012; Aregawi et al. 2018). However, general anesthesia is still used especially when regional anesthesia is contraindicated or failed. Advantages of general anesthesia include maintained patent airway, controlled ventilation, and less cardiovascular depression (Devroe et al. 2015). Complications such as failed intubation, failed ventilation, aspiration of gastric content, awareness, pain, and fetal depression (Yehuda Ginosar et al. 2013) are common in GA.

Conclusion of the study

Both anesthetic techniques are reliable and well-tolerated for cesarean delivery. However, regional anesthesia emerged as a better option for elective cesarean delivery. Regional anesthesia benefits for maternal and fetal outcome are superior to general anesthesia.

BMC Medicine

Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study

Background

Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections.

Methods

Cohorts of caesarean sections by indication (that is, planned repeat caesarean section, failure to progress, foetal distress) were selected from the period 1998 to 2004 (N = 50,806). Deliveries performed under general anaesthesia were compared with those performed under spinal or epidural, for the outcomes of neonatal intubation and 5-minute Apgar (Apgar5) <7.

Results

The risk of adverse outcomes was increased for caesarean sections under general anaesthesia for all three indications and across all levels of hospital. The relative risks were largest for low-risk planned repeat caesarean deliveries: resuscitation with intubation relative risk was 12.8 (95% confidence interval 7.6, 21.7), and Apgar5 <7 relative risk was 13.4 (95% confidence interval 9.2, 19.4). The largest absolute increase in risk was for unplanned caesareans due to foetal distress: there were five extra intubations per 100 deliveries and six extra Apgar5 <7 per 100 deliveries.

Conclusion

The infants most affected by general anaesthesia were those already compromised in utero, as evidenced by foetal distress. The increased rate of adverse neonatal outcomes should be weighed up when general anaesthesia is under consideration.

PLOS ONE

Effect of anaesthetic technique on neonatal morbidity in emergency caesarean section for foetal distress The primary aim of our study was to investigate the effect of the anaesthetic technique (i.e., regional or general anaesthesia) on neonatal morbidity in emergency caesareans. Length of hospitalization, and umbilical cord pH values were secondary outcomes.

Conclusions

While we did find some improved results for regional anaesthesia group, we found no statistical evidence that neither anaesthesia technique is superior regarding neonatal morbidity. We think that regional anaesthesia should be preferred whenever possible because of our improved results of length of hospital stay, APGAR and morbidity and we think that general anaesthesia is indicated for very urgent cases or regional anaesthesia contraindicated patients

Cesarean Section Anaesthesia

A cesarean section or C-section is an abdominal surgery that is performed to deliver a baby via an incision made in the abdomen and womb. Sometimes this is the safest option in cases where a normal vaginal birth may pose a risk to the mother or baby. Some examples of when a C-section may be needed include the following:

  • When the labour has not progressed naturally
  • When there is a history of two or more caesarean sections
  • When the baby is in the breech or bottom first position
  • When there is a complication called praevia, where the placenta lies inside the lower segment of the womb
  • When the mother is expecting twins or triplets

A C-section may be performed as an urgent procedure when complications have developed during pregnancy or labour or as an elective procedure, where the surgery has been planned in advance. When a C-section is carried out, anesthesia may be local, where the mother is awake but sensation in the lower body is numbed, or general, where the mother is unconscious during the delivery.

Local/regional anesthesia

Most C-sections are performed under local or regional anesthesia, which is usually a safer option than general anesthesia. Delivery of the baby takes around 5 to 10 minutes and the whole procedure is usually over within 40 or 50 minutes. There are three types of regional anesthesia that may be administered and these are described below.

Spinal anesthesia

Spinal anesthesia or spinal block is a common form of anesthesia used for both urgent and elective procedures. A single dose of regional anesthetic is injected into the fluid around the spinal cord using a needle. This numbs the nerves in the lower body, from the waist down to the toes, for around two to three hours. The benefit of spinal anesthesia is that it blocks pain quickly, with only a small dose of anesthetic being used. Spinal anesthesia is also referred to as saddle block anesthesia because it numbs the area of the body that would come into contact with a saddle if a person was on a horse.

Epidural anesthesia

Here, a sterile guide needle and a catheter are inserted into the epidural space, the space around the spinal nerves present in the lower back. The catheter is placed at or below waist level and area where the needle will be inserted is numbed with a local anesthetic. The needle is then inserted and removed, while the catheter stays in place, taped along the centre of the back. The anesthetic is then administered via the catheter, as required to numb the body above and below the injection point. An epidural requires a larger does of anesthetic than spinal anesthesia and it can take longer to work.