Regional versus general anaesthesia for caesarean section
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Abstract:
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To compare the effects of regional anaesthesia with those of general anaesthesia on the outcomes of caesarean section.Keywords:
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Section (typography)
Regional anaesthesia
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Although anaesthesia for Caesarean section is predominantly performed using regional techniques of anaesthesia, general anaesthesia will remain essential for subgroups of obstetric patients, especially those who are at high risk of complications. In the present review, recent reports that addressed issues regarding general and regional anaesthesia in Caesarean section will be discussed.
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Regional anaesthesia
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This study of the obstetric and anaesthetic circumstances relating to 100 consecutive Caesarean sections under general anaesthesia suggests that the general anaesthesia rate for Caesarean section could be reduced from the present 37 to 27% by making maximum use of epidural block and to 16% by using subarachnoid block in addition. The need for general anaesthesia on account of urgency to deliver can be greatly reduced by the administration of epidural analgesia during labour in patients identified as being more likely than average to require Caesarean section, and by the use of subarachnoid block when the need for section arises unexpectantly. Patients' objections to undergoing Caesarean section while conscious were analysed, and suggestions are made for minimising the number of patients who decline. Technical problems with blocks may sometimes be overcome without resort to general anaesthesia, while patients at risk from haemorrhage or coagulopathy will continue to require general anaesthesia.
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Extracted from text ... REVIEW
Southern African Journal of Anaesthesia & Analgesia - February 2004 15
Complications associated with regional
anaesthesia for Caesarean section
Complications of Regional Anaesthesia for CS
The three categories of RA currently employed for CS are:
1. Spinal (subarachnoid),
2. Epidural, and
3. Combined Spinal-Epidural (CSE) anaesthesia.
In the public sector most Caesarian Sections are performed
using SA. In this setting, epidural anaesthesia for labour is
infrequently used, so relatively few epidurals are extended for
CS.
Both maternal and fetal complications may occur as a consequence
of the use of RA. These may develop during administration
of the RA, ..
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Any anaesthetic technique, either regional or general, has potential for complications. Moreover, it has been seen that in obstetric patients, the complications are potentiated due to pregnancy-related changes in physiology and due to various other factors. Increasing trend of caesarean section in the setting of increasing maternal age, obesity and other concomitant diseases will continue to challenge the obstetric anaesthetist in his/her task of providing safe regional and general anaesthesia. This review has highlighted the possible complications of regional and general anaesthesia encountered during the obstetric anaesthesia practice.
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Regional anaesthesia is now a well recognized and accepted technique in the practice of paediatric anaesthesia. It may be used in conjunction with general anaesthesia or as an alternative to general anaesthesia, for example, in high-risk infants. This technique offers excellent postoperative pain relief. However, age-dependent and clinical differences must be recognized for safety.
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Regional anaesthesia
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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To compare the effects of regional anaesthesia with those of general anaesthesia on the outcomes of caesarean section.
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Section (typography)
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We conducted a postal survey of 221 anaesthetists in the Oxford region to determine their views and actual clinical practice regarding regional anaesthesia in adult patients undergoing limb surgery, when a combined regional and general anaesthetic was planned. Of the 162 respondents (73.3%), 142 (87.6%) regularly practised regional blocks for limb surgery in adult patients. For all the regional anaesthetic techniques in question, more anaesthetists felt it was safer to perform these blocks before induction of general anaesthesia than after induction. However, their actual practice varied markedly from their views, with more anaesthetists performing these blocks after general anaesthesia. Overall, trainees performed blocks before induction of general anaesthesia more often than consultants (p = 0.047).
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