OBSTETRIC ANAESTHESIA

Anaesthesia Management for Cesarean Section:

Regional Anaesthesia: preferred method (Anaesthesia risks):

• Preoperative: sodium citrat 30 ml p.o., ranitidine 50 mg, metoclopramide 10 mg i.v.
• Epidural Anaesthesia (except by known contraindications) with bupivacaine 0.5% und fentanyl 50 µg epidural
• Spinal Anaesthesia is more frequently contraindicated (problems of acute sympathicolysis with hypovolaemia, danger if intra-uterine asphyxia)
  • Volume therapy, if indicated guided by Central Venous Pressure (CVP) (see entry)
  • O2 via a nasal tube

General Anaesthesia: severe indications (Anaesthesia risks):

• pre-operative: sodium citrate 30 ml p.o., ranitidine 50 mg, metoclopramide 10 mg i.v.
• 1 -2 good i.v. access
• Intubation anaesthesia, frequent "difficult intubations" (tube size 7)
• Induction only after correction of hypertension (danger of hypertensive crisis with laryngoscopy): MgSO4, apresoline, labetalol, sodium nitroprusside, in worse cases, invasive measurement of blood pressure (blood gas)
• Carefully give 100% oxygen, assistance (cricoid pressure), induction with thiopental 4 mg/kg and succinylcholine 1-1.5 mg/kg, isoflurane and max. 50 % N2O in O2 until delivery, after the umbilical cord is clamped i.v. anaesthesia (fentanyl, midazolam, atracurium)
• Attention: stimulate uterine contraction with oxytocin 5 E i.v. and 15 E in RL 1000 ml, ergometrine is contra-indicated.

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