ANESTHESIA FOR CESAREAN SECTION
Cesarean birth has become the most common hospital-based operative
procedure in the United States and accounts for more than 25% of all live births.
[163]
Increased use of the procedure has been attributed
to the liberalization of indications for fetal "distress," as well as elective repeat
cesarean sections.[164]
The most common indications
for cesarean delivery include "failure to progress," non-reassuring fetal status,
cephalopelvic disproportion, malpresentation, prematurity, and previous uterine surgery.
The choice of anesthesia for cesarean section depends on the indications for the
surgery, the degree of urgency, maternal status, and desires of the patient.
Regional Anesthesia for Cesarean Section
The use of regional anesthesia has dramatically increased, and
data since 1997 suggest that the use of general anesthesia for cesarean section has
been steadily decreasing in
the United States.[165]
Regional anesthesia techniques
have several advantages, including a decreased risk of failed intubation and aspiration
of gastric contents, avoidance of depressant agents, and the ability of the mother
to remain awake and enjoy the birthing experience. In addition, it has been suggested
that blood loss is reduced under regional anesthesia for cesarean delivery.[166]
Although epidural, spinal, continuous spinal, and CSE techniques
have all been advocated, most straightforward cesarean sections are now performed
with single-shot spinal anesthesia, which has been found to be faster, provides a
superior block, and is more cost-effective.[167]
