Difference between revisions of "Cesarean section"
From WikiAnesthesia
| Line 4: | Line 4: | ||
| lines_access = | | lines_access = | ||
| monitors = | | monitors = | ||
| considerations_preoperative = | | considerations_preoperative = Full stomach precautions <br> | ||
as | |||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| considerations_postoperative = | | considerations_postoperative = | ||
| Line 24: | Line 25: | ||
|Cardiovascular | |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 | |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 PaO<sub>2.</sub> | |||
* Increased MV and decreased FRC increase uptake of inhalational agents. | |||
* Mucosal capillary engorgement in upper airway may necessitate smaller endotracheal tube. | |||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| | | | ||
* Increased gastric pressure | |||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | | | ||
* | |||
|- | |- | ||
|Renal | |Renal | ||
| Line 57: | Line 67: | ||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
* Avoid nasal airways due to potential for mucosal capillary engorgement in upper airway | |||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
* Left lateral tilt (15<sup>o</sup>) to avoid aortocaval compression and supine hypotension. | |||
=== 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. --> === | ||
* Immediately post-partum, ~600-800 mL of blood will enter the central circulation (placental autotransfusion), which will increase cardiac output | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
Revision as of 11:06, 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
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
- 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.