Cesarean section

Cesarean section

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative	Full stomach precautions as
Intraoperative
Postoperative
Article quality
Editor rating	Comprehensive
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.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular	Pregnant patients typically have decreased systemic vascular resistance, decreased diastolic pressure, decreased MAP, increased HR, and increased CO. Left uterine tilt to minimize aortocaval compression
Respiratory	Pregnant patients typically have compensated respiratory alkalosis, increased minute ventilation, decreased FRC, and increased oxygen consumption. Decreased FRC results in rapid desaturation if ventilation is compromised. Atelectasis can occur secondary to an elevated diaphragm, thereby causing V/Q mismatch and decreased PaO2. Increased MV and decreased FRC increase uptake of inhalational agents. Mucosal capillary engorgement in upper airway may necessitate smaller endotracheal tube.
Gastrointestinal	Increased gastric pressure
Hematologic
Renal
Endocrine
Other

Intraoperative management

Induction and airway management

• Avoid nasal airways due to potential for mucosal capillary engorgement in upper airway

Positioning

• Left lateral tilt (15^o) to avoid aortocaval compression and supine hypotension.

Maintenance and surgical considerations

• Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications