Difference between revisions of "Cesarean section"

From WikiAnesthesia
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| monitors =  
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| considerations_preoperative = Full stomach precautions <br>
| considerations_preoperative = Full stomach precautions <br>
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Aspiration prophylaxis <br>
Left lateral tilt
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| considerations_intraoperative =  
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* Increased gastric pressure
* Increased gastric pressure
* Decreased esophageal sphincter tone
* Decreased gastric motility
* Full stomach precautions
* Risk for aspiration
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|Hematologic
|Hematologic
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* 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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*
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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. --> ===
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=== 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 11:16, 23 February 2021

Cesarean section
Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative

Full stomach precautions
Aspiration prophylaxis
Left lateral tilt

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[1].

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
  • Decreased esophageal sphincter tone
  • Decreased gastric motility
  • Full stomach precautions
  • Risk for aspiration
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.
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

  1. "Births: Provisional Data for 2017" (PDF). CDC. May 2018. Retrieved 18 May 2018.