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Anaesthesia for urgent (grade 1) caesarean section

Dahl, Vegarda; Spreng, Ulrich Jb

Current Opinion in Anesthesiology: June 2009 - Volume 22 - Issue 3 - p 352–356
doi: 10.1097/ACO.0b013e3283294c37
Obstetric and gynecological anesthesia: Edited by Marc Van de Velde

Purpose of review We describe the different possible anaesthetic techniques for an emergency caesarean section. To choose the right method of anaesthesia may have major implications for mother, child and all involved personnel. The major controversy is whether one have other or better alternatives or both than general anaesthesia, with a rapid sequence induction technique, when the foetus is compromised.

Recent findings Recently published studies indicate that a top-up of a well functioning labour epidural is as fast as general anaesthesia, and that the top-up can be performed during preparation and transport. Spinal anaesthesia, when performed by skilled anaesthetists, is as fast or almost as fast as general anaesthesia with a very low failure rate. Combined spinal/epidural may have advantages, especially in high-risk cardiac patients, but is too time-consuming. General anaesthesia still seems to be the method of choice for most anaesthetists in extremely urgent settings. The major disadvantage with general anaesthesia is the risk of failure and the dramatic consequences of a ‘cannot intubate, cannot ventilate’ situation. Awareness is another concern, and the incidence varies from 0.26 to 1% in recent literature.

Summary Regional anaesthesia techniques such as a single-shot spinal or a top-up of a well functioning labour epidural analgesia are good alternatives to general anaesthesia in an emergency caesarean setting.

aDepartment of Anaesthesia and Intensive Care, Asker and Baerum Hospital, Rud, Norway

bUllevaal University Hospital, Oslo, Norway

Correspondence to Vegard Dahl, MD, PhD, Head of Department, Department of Anaesthesia and Intensive Care, Asker and Baerum Hospital, Box 83, N-1307 Rud, Norway Tel: +47 67809400; fax: +47 67809976; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.