Difference between revisions of "Cesarean section"
From WikiAnesthesia
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| monitors = | | monitors = | ||
| considerations_preoperative = Full stomach precautions <br> | | considerations_preoperative = Full stomach precautions <br> | ||
Aspiration prophylaxis <br> | |||
Left lateral tilt | |||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| considerations_postoperative = | | considerations_postoperative = | ||
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| | | | ||
* Increased gastric pressure | * Increased gastric pressure | ||
* Decreased esophageal sphincter tone | |||
* Decreased gastric motility | |||
* Full stomach precautions | |||
* Risk for aspiration | |||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | | | ||
* Increased RBC mass, plasma volume, and blood volume | |||
* Leukocytosis | |||
* Iron deficiency anemia + dilutional anemia of pregnancy | |||
* Excessive blood loss possible with uterine atony, multiple gestation, previous C-section, placental pregnancy, placental abruption, pregnancy induced hypertension, or prolonged labor. | |||
* | * | ||
|- | |- | ||
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=== Patient preparation and premedication === | === Patient preparation and premedication === | ||
* Full stomach precautions | |||
* Nonparticulate oral antacid (e.g. sodium citrate) immediately prior to general or regional anesthesia | |||
* Intravenous promotility agent (eg. metoclopramide) | |||
* Intravenous antacids (e.g. ranitidine, famotidine) | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
| Line 76: | Line 91: | ||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* Anticipate EBL of 700-1000 mL | |||
** Be prepared for excessive blood loss if underlying risk factors | |||
* Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output | * Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output | ||
Revision as of 10:16, 23 February 2021
Cesarean section
| Anesthesia type | |
|---|---|
| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative |
Full stomach precautions |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 2 |
A Cesarean section, also known as C-section, is a surgical procedure where the baby is delivered through an incision in the uterus. C-sections are typically performed when a vaginal delivery would put the mother or baby at risk. As of 2017, about 32% of deliveries in the United States were performed via C-section[1].
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular |
|
| Respiratory |
|
| Gastrointestinal |
|
| Hematologic |
|
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
- Full stomach precautions
- Nonparticulate oral antacid (e.g. sodium citrate) immediately prior to general or regional anesthesia
- Intravenous promotility agent (eg. metoclopramide)
- Intravenous antacids (e.g. ranitidine, famotidine)
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
- Avoid nasal airways due to potential for mucosal capillary engorgement in upper airway
Positioning
- Left lateral tilt (15o) to avoid aortocaval compression and supine hypotension.
Maintenance and surgical considerations
- Anticipate EBL of 700-1000 mL
- Be prepared for excessive blood loss if underlying risk factors
- Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ "Births: Provisional Data for 2017" (PDF). CDC. May 2018. Retrieved 18 May 2018.