Anesthesia during cesarean section

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The article presents clinical recommendations (treatment protocols) related to anesthesia during cesarean section. Indications and contraindications on choosing different methods of anesthesia are reviewed. The algorithms of management of patients with different methods of anesthesia with the assessment of their effectiveness are presented.

Keywords:

cesarean section

general anesthesia

neuroaxial anesthesia

complications of anesthesia

local anesthetics

Authors:

Kulikov A.V.

SPIN RSCI: 3736-8965
Scopus AuthorID: 35773365600
ResearcherID: C-6924-2016
ORCID: 0000-0002-9980-9226

Ovezov A.M.

MONIKI, Moscow, Russia

SPIN RSCI: 9263-8834
Scopus AuthorID: 23474305000
ResearcherID: AAP-3404-2021
ORCID: 0000-0001-7629-6280

Shifman E.M.

M.F. Vladimirsky Moscow Regional Research Clinical Institute, Ministry of Health of the Moscow Region, Moscow, Russia

SPIN RSCI: 4582-8494
Scopus AuthorID: 6507655298
ResearcherID: AAY-3981-2020
ORCID: 0000-0002-6113-8498

List of references:

McQuaid E, Leffert LR, Bateman BT. The role of the anesthesiologist in preventing severe maternal morbidity and mortality. Clin Obstet Gynecol. 2018;61(2):372-386. https://doi.org/10.1097/GRF.0000000000000350
Neuhaus S, Neuhaus C, Fluhr H, Hofer S, Schreckenberger R, Weigand MA, Bremerich D. «Why mothers die». Learning from the analysis of anaesthesia-related maternal deaths (1985—2013). Anaesthesist. 2016;65(4):281-294. https://doi.org/10.1007/s00101-016-0155-6
Abir G, Mhyre J. Maternal mortality and the role of the obstetric anesthesiologist. Best Pract Res Clin Anaesthesiol. 2017;31(1):91-105. https://doi.org/10.1016/j.bpa.2017.01.005
Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979—2002. Obstet Gynecol. 2011;117(1):69-74. https://doi.org/10.1097/AOG.0b013e31820093a9
Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018;73(Suppl.1):61-66. https://doi.org/10.1111/anae.14141
Chestnut DH, Wong CA, Tsen LC, Warwick D. Ngan Kee, Beilin Y, Mhyre JM. Chestnut’s obstetric anesthesia. Principles and practice. 5th ed. Philadelphia: Elsevier Saunders; 2014.
Chassed D. Maternal deaths due to anesthesia complications. Results from the French confidential enquiry into maternal deaths, 2010—2012. Gynecol Obstet Fertil Senol. 2017;45(12,Suppl.):S54-S57. https://doi.org/10.1016/j.gofs.2017.10.028
Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012;(10):CD004350. https://doi.org/10.1002/14651858.CD004350.pub2
Sobhy S, Zamora J, Dharmarajah K, Arroyo-Manzano D, Wilson M, Navaratnarajah R, Coomarasamy A, Khan KS, Thangaratinam S. Anaesthesia-related maternal mortality in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(5):e320-e327. https://doi.org/10.1016/S2214-109X(16)30003-1
Surech MS, Segal BS, Preston RL, Fernando R, Mason CL, eds. Shnider and Levinson’s anesthesia for obstetrics. 5th ed. Lippincott Williams & Wilkins; 2013.
Clark V, Van de Velde M, Fernando R, eds. Oxford textbook of obstetric anaesthesia. Oxford University Press; 2016.
Ouzounian JG, Elkayam U. Physiologic changes during normal pregnancy and delivery. Cardiol Clin. 2012;30(3):317-329.
Schaefer Ch, Peters P, Miller RK, eds. Drugs during pregnancy and lactation. Treatment options and risk assessment. 3rd ed. Elsevier; 2015.
American Society of Anesthesiologists. ASA physical status classification system. Last approved by the ASA House of Delegates on October 15, 2014.
Royal College of Obstetricians and Gynaecologists. Classification of urgency of caesarean section — a continuum of risk Good Practice No. 11 April 2010.
Soltanifar S, Russell R. The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. Int J Obstet Anesth. 2012;21(3):264-272. https://doi.org/1016/j.ijoa.2012.03.004
Mellin-Olsen J, Staender S, Whitaker DK, Smith AF. The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol. 2010;27(7):592-597. https://doi.org/10.1097/EJA.0b013e32833b1adf
Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Techniques: An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2017;126(4):585-601. https://doi.org/10.1097/ALN.0000000000001521
Association of Anaesthetists of Great Britain and Ireland (AAGBI); Hartle A, Anderson E, Bythell V, Gemmell L, Jones H, McIvor D, Pattinson A, Sim P, Walker I. Checking anaesthetic equipment 2012: association of anaesthetists of Great Britain and Ireland. Anaesthesia. 2012;67(6):660-668.
WHO Surgical Safety Checklist for maternity. December 2010.
Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev. 2014;(12):CD009516.
van Schalkwyk J, Van Eyk N. No.247-antibiotic prophylaxis in obstetric procedures. J Obstet Gynaecol Can. 2017;39(9):e293-e299.
Sway A, Solomkin JS, Pittet D, Kilpatrick C. Methodology and background for the World Health Organization global guidelines on the prevention of surgical site infection. Surg Infect (Larchmt). 2018;19(1):33-39. https://doi.org/10.1089/sur.2017.076
Kawakita T, Landy HJ. Surgical site infections after cesarean delivery: epidemiology, prevention and treatment. Matern Health Neonatol Perinatol. 20175;3:12. https://doi.org/10.1186/s40748-017-0051-3
Ministerstvo zdravookhraneniya Rossiiskoi Federatsii. Pis’mo N15-4/10/2-3190 ot 06.05.14. Kesarevo sechenie. Pokazaniya, metody obezbolivaniya, khirurgicheskaya tekhnika, antibiotikoprofilaktika, vedenie posleoperatsionnogo perioda. Klinicheskie rekomendatsii (protokol). (In Russ.)
Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, Brown DL, Heit JA, Mulroy MF, Rosenquist RW, Tryba M, Yuan CS. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med. 2010;35(1):64-101.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH, Dunn AS, Kunz R. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2:Suppl.):e326S-350S. https://doi.org/10.1378/chest.11-2298
Leffert L, Butwick A, Carvalho B, Arendt K, Bates SM, Friedman A, Horlocker T, Houle T, Landau R, Dubois H, Fernando R, Houle T, Kopp S, Montgomery D, Pellegrini J, Smiley R, Toledo P; Members of the SOAP VTE Taskforce. The Society for Obstetric Anesthesia and perinatology consensus statement on the anesthetic management of pregnant and postpartum women receiving thromboprophylaxis or higher dose anticoagulants. Anesth Analg. 2018;126(3):928-944. https://doi.org/10.1213/ANE.0000000000002530
Keeling D, Tait RC, Watson H; British Committee of Standards for Haematology. Peri-operative management of anticoagulation and antiplatelet therapy. Br J Haematol. 2016;175(4):602-613. https://doi.org/10.1111/bjh.14344
Working Party: Association of Anaesthetists of Great Britain & Ireland; Obstetric Anaesthetists’ Association; Regional Anaesthesia UK. Regional anaesthesia and patients with abnormalities of coagulation: the Association of Anaesthetists of Great Britain & Ireland The Obstetric Anaesthetists’ Association Regional Anaesthesia UK. Anaesthesia. 2013;68(9):966-972. h https://doi.org/10.1111/anae.12359
Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71-92. https://doi.org/10.1111/anae.14080
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124(2):270-300. https://doi.org/10.1097/ALN.0000000000000935
Prevention and management of postpartum haemorrhage: Green-top guideline No. 52. BJOG. 2017;124(5):e106-49. https://doi.org/10.1111/1471-0528.14178
Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum hemorrhage. Obstet. Gynecol. 2017;130(4):e168-186. https://doi.org/10.1097/AOG.0000000000002351
Fuchs F, Benhamou D. Post-partum management after cesarean delivery. Guidelines for clinical practice. J Gynecol Obstet Biol Reprod (Paris). 2015;44 (10):1111-1117. https://doi.org/10.1016/j.jgyn.2015.09.020
Prikaz Ministerstva zdravookhraneniya Rossiiskoi Federatsii №919n ot 15.11.12. Ob utverzhdenii Poryadka okazaniya meditsinskoi pomoshchi vzroslomu naseleniyu po profilyu «anesteziologiya i reanimatologiya». [Prikaz Ministerstva zdravookhraneniya Rossiiskoi Federatsii №919n ot 15.11.12. Ob utverzhdenii Poryadka okazaniya meditsinskoi pomoshchi vzroslomu naseleniyu po profilyu «anesteziologiya i reanimatologiya».( in Russ.)].
Carvalho B, Butwick AJ. Postcesarean delivery analgesia. Best Pract Res Clin Anaesthesiol. 2017;31(1):69-79. https://doi.org/10.1016/j.bpa.2017.01.003
Kaye AD, Helander EM, Vadivelu N, Lumermann L, Suchy T, Rose M, Urman RD. Consensus statement for clinical pathway development for perioperative pain management and care transitions. Pain Ther. 2017;6(2):129-141. https://doi.org/10.1007/s40122-017-0079-0
Tsai HC, Yoshida T, Chuang TY, Yang SF, Chang CC, Yao HY, Tai YT, Lin JA, Chen KY. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:8284363. https://doi.org/10.1155/2017/8284363
Ducloy-Bouthors AS, Baldini A, Abdul-Kadir R, Nizard J; ESA VTE Guidelines Task Force. European guidelines on perioperative venous thromboembolism prophylaxis: Surgery during pregnancy and the immediate postpartum period. Eur J Anaesthesiol. 2018;35(2):130-133. https://doi.org/10.1097/EJA.0000000000000704
Devroe S, Van de Velde M, Rex S. General anesthesia for caesarean section. Curr Opin Anaesthesiol. 2015;28(3):240-246. https://doi.org/10.1097/ACO.0000000000000185
Capogna G, ed. Anesthesia for cesarean section. Springer; 2017.
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-393.
Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A; American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118(2):251-270. https://doi.org/10.1097/ALN.0b013e31827773b2
Piepho T, Cavus E, Noppens R, Byhahn C, Dörges V, et al. S1 guidelines on airway management: Guideline of the German Society of Anesthesiology and Intensive Care Medicine. Anaesthesist. 2015;64(Suppl.1):27-40.
Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, Quinn AC. Obstetric Anaesthetists’ Association; Difficult Airway Society. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015;70(11):1286-1306. https://doi.org/10.1111/anae.13260
Ramkumar V, Dinesh E, Shetty SR, Shah A, Kundra P, Das S, Myatra SN, Ahmed SM, Divatia JV, Patwa A, Raveendra US, Doctor JR, Pawar DK, Ramesh S. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics. Indian J Anaesth. 2016;60(12):899-905. https://doi.org/10.4103/0019-5049.195482
Shifman EM, Filippovich GV. Spinnomozgovaya anesteziya v akusherstve. Petrozavodsk: IntelTek; 2005;558. (In Russ.)
Guidelines for neuraxial anesthesia in obstetrics. ASA House of Delegates on October 12, 1988, and last amended on October 16, 2013.
Committee on Practice Bulletins — Obstetrics. Practice Bulletin No. 177: Obstetric analgesia and anesthesia. Obstet Gynecol. 2017;129(4):e73-e89.
Campbell JP, Stocks GM. Management of hypotension with vasopressors at caesarean section under spinal anaesthesia — have we found the Holy Grail of obstetric anaesthesia? Anaesthesia. 2018;73(1):3-6. https://doi.org/10.1111/anae.14114

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