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Current practice in obstetric anaesthesia. Part II General anaesthesia for Caesarean Section


Authors: Bláha Jan 1,2;  Nosková Pavlína 1,2;  Klozová Radka 1,3;  Seidlová Dagmar 1,4;  Štourač Petr 1,5;  Pařízek Antonín 6
Authors‘ workplace: Expertní skupina porodnické anestezie a analgezie ČSARIM 1;  Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF UK v Praze a Všeobecná fakultní nemocnice v Praze 2;  Klinika anesteziologie a resuscitace, 2. LF UK v Praze a Fakultní nemocnice v Motole 3;  II. anesteziologicko-resuscitační oddělení Fakultní nemocnice Brno 4;  Klinika anesteziologie, resuscitace a intenzivní medicíny, LF Masarykovy univerzity a Fakultní nemocnice Brno 5;  Gynekologicko-porodnická klinika, 1. LF UK v Praze a Všeobecná fakultní nemocnice v Praze 6
Published in: Anest. intenziv. Med., 24, 2013, č. 3, s. 186-192
Category: Postgraduate education

Overview

General anaesthesia for Caesarean Section remains the method of choice in life-threatening situations for the mother or foetus. Although meta-analyses of studies comparing neuraxial and general anaesthesia did not find significant differences in maternal mortality or in the influence of different types of anaesthesia on the outcome of in-term born babies (discussed in more details in the previous article, Current Practice in Obstetric Anaesthesia I.), general anaesthesia for Caesarean Section should be always given with maximum caution. In this article we discuss general anaesthesia for Caesarean Section especially in terms of difficult intubation, risk of aspiration, induction and muscle relaxation.

Keywords:
Caesarean section – general anaesthesia – difficult intubation – aspiration – introduction to general anaesthesia – muscle relaxation


Sources

1. Afolabi, B. B., Lesi, F. E., Merah, N. A. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst. Rev., 2006, 4, CD004350.

2. Reynolds, F., Seed, P. T. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia, 2005, 60, 7, p. 636–653.

3. Sigalas, J., Galazios, G., Tsikrikoni, I., Scordala, M., Vogiatjaki, T., Spanopoulou, P. I., Tsikouras, P. The influence of the mode of anaesthesia in the incidence of neonatal morbidity after anelective caesarean section. Clin. Exp. Obstet. Gynecol., 2006, 33, 1, p. 10-12.

4. Jain, K., Bhardwaj, N., Sharma, A., Kaur, J., Kumar, P. A randomised comparison of the effects of low-dose spinal or general anaesthesia on umbilical cord blood gases during caesarean delivery of growth-restricted foetuses with impaired Doppler flow. Eur. J. Anaest., 2012.

5. Mallampati, S. R., Gatt, S. P., Gugino, L. D., Desai, S. P., Waraksa, B., Freiberger, D., Liu, P. L. A clinical sign to predict difficult tracheal intubation: a prospective study. Can. Anaesth. Soc. J., 1985, 32, 4, p. 429–434.

6. Chestnut, D. H. Obstetric Anesthesia: Principles and Practice.4 edn. Philadelphia: Mosby, Elsevier Inc., 2009.

7. Rahman, K., Jenkins, J. G. Failed tracheal intubation in obstetrics: no more frequent but still managed badly. Anaesthesia, 2005, 60, 2, p. 168–171.

8. McDonnell, N. J., Paech, M. J., Clavisi, O. M., Scott, K. L. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int. J. Obstet. Anesth., 2009, 17, 4, p. 292–297.

9. Lyons, G., Akerman, N. Problems with general anaesthesia for Caesarean section. Minerva Anestesiol., 2005, 71, 1–2, p. 27–38.

10. Barnardo, P. D., Jenkins, J. G. Failed tracheal intubation in obstetrics: a 6-year review in a UK region. Anaesthesia, 2000, 55, 7, p. 690–694.

11. Kodali, B. S., Chandrasekhar, S., Bulich, L. N., Topulos, G. P., Datta, S. Airway changes during labor and delivery. Anesthesiology, 2008, 108, 3, p. 357–362.

12. Boutonnet, M., Faitot, V., Katz, A., Salomon, L., Keita, H. Mallampati class changes during pregnancy, labour, and after delivery: can these be predicted? Br. J. Anaesth., 2010, 104, 1, p. 67–70.

13. McAuliffe, F., Kametas, N., Espinoza, J., Greenough, A., Nicolaides, K. Respiratory function in pregnancy at sea level and at high altitude. BJOG, 2004, 111, 4, p. 311–315.

14. McAuliffe, F., Kametas, N., Costello, J., Rafferty, G. F., Greenough, A., Nicolaides, K. Respiratory function in singleton and twin pregnancy. BJOG, 2002, 109, 7, p. 765–769.

15. Hignett, R., Fernando, R., McGlennan, A., McDonald, S., Stewart, A., Columb, M., Adamou, T., Dilworth, P. A randomized crossover study to determine the effect of a 30 degrees head-up versus a supine position on the functional residual capacity of term parturients. Anesth. Analg., 2011, 113, 5, p. 1098–1102.

16. Tanoubi, I., Drolet, P., Donati, F. Optimizing preoxygenation in adults. Canadian journal of anaesthesia = Journal canadiend‘anesthesie, 2009, 56, 6, p. 449–466.

17. Farmery, A. D., Roe, P. G. A model to describe the rate of oxyhaemoglobin desaturation during apnoea. Brit. J. Anaest., 1996, 76, 2, p. 284–291.

18. Benumof, J. L., Dagg, R., Benumof, R. Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology, 1997, 87, 4, p. 979–982.

19. Tanoubi, I. Oxygenation before anesthesia (preoxygenation) in adults. Anesthesiology Rounds, 2006, vol. 5. Department of Anesthesiology, University of Montreal

20. Lee, A., Fan, L. T., Gin, T., Karmakar, M. K., Ngan, Kee, W. D. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth. Analg., 2006, 102, 6, p. 1867–1878.

21. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology, 2007, 106, 4, p. 843–863.

22. McDonnell, N. J., Paech, M. J., Clavisi, O. M., Scott, K. L. Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management and complications associated with general anaesthesia for caesarean section. Int. J. Obstet. Anesth., 2008, 17, 4, p. 292–297.

23. Ezri, T., Szmuk, P., Stein, A., Konichezky, S., Hagai, T., Geva, D. Peripartum general anasthesia without tracheal intubation: incidence of aspiration pneumonia. Anaesthesia, 2000, 55, 5, p. 421–426.

24. Wong, C. A., McCarthy, R. J., Fitzgerald, P. C., Raikoff, K., Avram, M. J. Gastric emptying of water in obese pregnant women at term. Anesth. Analg., 2007, 105, 3, p. 751–755.

25. Wong, C. A., Loffredi, M., Ganchiff, J. N., Zhao, J., Wang, Z., Avram, M. J. Gastric emptying of water in term pregnancy. Anesthesiology, 2002, 96, 6, p. 1395–1400.

26. Herman, N. L., Carter, B., Van Decar, T. K. Cricoid pressure: teaching the recommended level. Anesth. Analg., 1996, 83, 4, p. 859–863.

27. Sharp, L. M., Levy, D. M. Rapid sequence induction in obstetrics revisited. Current. opinion in anaesthesiology, 2009, 22, 3, p. 357–361.

28. Priebe, H. J. Cricoid pressure: an expert‘s opinion. Minervaanestesiologica, 2009, 75, 12, p. 710–714.

29. Smith, K. J., Dobranowski, J., Yip, G., Dauphin, A., Choi, P. T. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology, 2003, 99, 1, p. 60–64.

30. Garrard, A., Campbell, A. E., Turley, A., Hall, J. E. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia, 2004, 59, 5, p. 435–439.

31. Haslam, N., Parker, L., Duggan, J. E. Effect of cricoid pressure on the view at laryngoscopy. Anaesthesia, 2005, 60, 1, p. 41–47.

32. Quigley, P., Jeffrey, P. Cricoid pressure: assessment of performance and effect of training in emergency department staff. EMA, 2007, 19, 3, p. 218–222.

33. Priebe, H. J. Cricoid pressure: an evidence-based practice? Middle East J. Anesthesiol., 2005, 18, 3, p. 485–492.

34. Mac, G. P. J. H., Ball, D. R. The effect of cricoid pressure on the cricoid cartilage and vocal cords: an endoscopic study in anae-sthetised patients. Anaesthesia, 2000, 55, 3, p. 263–268.

35. Gaitini, L., Vaida, S., Collins, G., Somri, M., Sabo, E. Awareness detection during caesarean section under general anaesthesia using EEG spectrum analysis. Can. J. Anaesth., 1995, 42, 5, 1, p. 377–381.

36. Schultetus, R. R., Hill, C. R., Dharamraj, C. M., Banner, T. E., Berman, L. S. Wakefulness during cesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined. Anesth. Analg., 1986, 65, 7, p. 723–728.

37. Finster, M., Morishima, H. O., Mark, L. C., Perel, J. M., Dayton, P. G., James, L. S. Tissue thiopental concentrations in the fetus and newborn. Anesthesiology, 1972, 36, 2, p. 155–158.

38. Flowers, C. E. Jr. The placental transmission of barbiturates and thiobarbiturates and their pharmacological action on the mother and the infant. Am. J. Obstet. Gynecol., 1959, 78, p. 730–742.

39. Yau, G., Gin, T., Ewart, M. C., Kotur, C. F., Leung, R. K., Oh, T. E. Propofol for induction and maintenance of anaesthesia at caesarean section. A comparison with thiopentone/enflurane. Anaesthesia, 1991, 46, 1, p. 20–23.

40. Celleno, D., Capogna, G., Tomassetti, M., Costantino, P., Di Feo, G., Nisini, R. Neurobehavioural effects of propofol on the neonate following elective caesarean section. Br. J. Anaesth., 1989, 62, 6, p. 649–654.

41. Gin, T., Gregory, M. A., Chan, K., Buckley, T., Oh, T. E. Pharmacokinetics of propofol in women undergoing elective caesarean section. Br. J. Anaesth., 1990, 64, 2, p. 148–153.

42. Celleno, D., Capogna, G., Emanuelli, M., Varrassi, G., Muratori, F., Costantino, P., Sebastiani, M. Which induction drug for cesarean section? A comparison of thiopental sodium, propofol, and midazolam. J. Clin. Anesth., 1993, 5, 4, p. 284–288.

43. Baraka, A. Severe bradycardia following propofol-suxamethonium sequence. Br. J. Anaesth., 1988, 61, 4, p. 482–483.

44. Nayar, R., Sahajanand, H. Does anesthetic induction for Cesarean section with a combination of ketamine and thiopentone confer any benefits over thiopentone or ketamine alone? A prospective randomized study. Minerva anestesiologica, 2009, 75, 4, p. 185–190.

45. Ngan Kee, W. D., Khaw, K. S., Ma, K. C., Wong, A. S., Lee, B. B., Ng, F. F. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial. Anesthesiology, 2006, 104, 1, p. 14–20.

46. Downing, J. W., Mahomedy, M. C., Jeal, D. E., Allen, P. J. Anaesthesia for Caesarean section with ketamine. Anaesthesia, 1976, 31, 7, p. 883–892.

47. Ngan Kee, W. D., Khaw, K. S., Ma, M. L., Mainland, P. A., Gin, T.Postoperative analgesic requirement after cesarean section: a comparison of anesthetic induction with ketamine or thiopental. Anesth. Analg., 1997, 85, 6, p. 1294–1298.

48. Krissel, J., Dick, W. F., Leyser, K. H., Gervais, H., Brockerhoff, P., Schranz, D. Thiopentone, thiopentone/ketamine, and ketamine for induction of anaesthesia in caesarean section. Eur. J. Anaesthesiol., 1994, 11, 2, p. 115–122.

49. Naguib, M., Samarkandi, A. H., El-Din, M. E., Abdullah, K., Khaled, M., Alharby, S. W. The dose of succinylcholine required for excellent endotracheal intubating conditions. Anesth. Analg., 2006, 102, 1, p. 151–155.

50. Thind, G. S., Bryson, T. H. Single dose suxamethonium and muscle pain in pregnancy. Br. J. Anaesth., 1983, 55, 8, p. 743–745.

51. Mencke, T., Knoll, H., Schreiber, J. U., Echternach, M., Klein, S.,Noeldge-Schomburg, G., Silomon, M. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial. Anesth. Analg., 2006, 102, 3, p. 943–949.

52. Abu-Halaweh, S. A., Massad, I. M., Abu-Ali, H. M., Badran, I. Z.,Barazangi, B. A., Ramsay, M. A. Rapid sequence induction and intubation with 1 mg/kg rocuronium bromide in cesarean section, comparison with suxamethonium. Saudi medical journal, 2007, 28, 9, p. 1393–1396.

53. Williamson, R. M., Mallaiah, S., Barclay, P. Rocuronium and sugammadex for rapid sequence induction of obstetric general anaesthesia. Acta Anaesthesiol. Scand., 2011, 55, 6, p. 694–699.

54. Sorensen, M. K., Bretlau, C., Gatke, M. R., Sorensen, A. M., Rasmussen, L. S. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Brit. J. Anaesth., 2012, 108, 4, p. 682–689.

55. Nauheimer, D., Kollath, C., Geldner, G. Modified rapid sequence induction for Caesarian sections : Case series on the use of rocuronium and sugammadex. Der Anaesthesist, 2012, 61, 8, p. 691–695.

56. Baraka, A. S., Sayyid, S. S., Assaf, B. A. Thiopental-rocuronium versus ketamine-rocuronium for rapid-sequence intubation in parturients undergoing cesarean section. Anesth. Analg., 1997, 84, 5, p. 1104–1107.

57. Naguib, M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth. Analg., 2007, 104, 3, p. 575–581.

58. Levy, D. M. Traditional rapid sequence induction is an outmoded technique for caesarean section and should be modified. Proposed. Int. J. Obstet. Anesth., 2006, 15, 3, p. 227–229.

59. Khaw, K. S., Ngan Kee, W. D. Fetal effects of maternal supplementary oxygen during Caesarean section. Curr. Opin Anaesthesiol., 2004, 17, 4, p. 309–313.

60. Parpaglioni, R., Capogna, G., Celleno, D., Fusco, P. Intraoperative fetal oxygen saturation during Caesarean section: general anaesthesia using sevoflurane with either 100% oxygen or 50% nitrous oxide in oxygen. Eur. J. Anaesthesiol., 2002, 19, 2, p. 115–118.

61. Matthews, P., Dann, W. L., Cartwright, D. P., Taylor, E. Inspired oxygen concentration during general anaesthesia for caesarean section. Eur. J. Anaesthesiol., 1989, 6, 4, p. 295–301.

62. Palahniuk, R. J., Shnider, S. M., Eger, E. I. 2nd Pregnancy decreases the requirement for inhaled anesthetic agents. Anesthesiology, 1974, 41, 1, p. 82–83.

63. Gin, T., Chan, M. T. Decreased minimum alveolar concentra-tion of isoflurane in pregnant humans. Anesthesiology, 1994, 81, 4, p. 829–832.

64. Chan, M. T., Gin, T. Postpartum changes in the minimum alveolar concentration of isoflurane. Anesthesiology, 1995, 82, 6, p. 1360–1363.

65. Levinson, G., Shnider, S. M., DeLorimier, A. A., Steffenson, J. L.Effects of maternal hyperventilation on uterine blood flow and fetal oxygenation and acid-base status. Anesthesiology, 1974, 40, 4, p. 340–347.

66. Muller, G., Huber, J. C., Salzer, H., Reinold, E. Maternal hyperventilation as a possible cause of fetal tachycardia sub partu. A clinical and experimental study. Gynecol. Obstet. Invest., 1984, 17, 5, p. 270–275.

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