Which anesthesia is better to choose for a cesarean section?

Selecting the appropriate anesthesia is a crucial decision to make when getting ready for a cesarean section. During the procedure, this decision has a direct impact on the mother’s comfort and the baby’s safety. Knowing your options can ease your anxiety and make the process go more smoothly.

For a cesarean section, general anesthesia and regional anesthesia—which includes spinal and epidural blocks—are usually the two main forms of anesthesia. Depending on the mother’s preferences and health as well as the specifics of the birth, each method has pros and cons of its own.

The advantages and disadvantages of each anesthetic type will be discussed in this article to assist you in selecting the best option for your cesarean section.

What is taken into account when choosing?

The procedure involves making an incision in the anterior abdominal wall, the uterus, extracting the child, and manually separating the placenta. The uterus is then sutured internally, and the peritoneum is sutured externally. Since the surgical procedure takes anywhere from 20 minutes to an hour (especially in complicated and severe cases), local superficial anesthesia cannot be used for such an operation.

These days, two forms of anesthesia are used during a cesarean section: general anesthesia and epidural (also known as spinal or spinal). General anesthesia is typically used by default in emergency cesarean sections, which are performed to save the mother’s and child’s lives in the event that a natural birthing attempt fails. It is typically only when the procedure is prearranged that the issue of selecting a pain management strategy for a cesarean section is resolved beforehand.

In this instance, physicians assess numerous variables. First and foremost, the health of the expectant mother and the developing fetus, as well as the potential effects of painkillers on the mother and child. Consideration must be given to specific indications and contraindications for various forms of anesthesia. Contraindications exist for both regional anesthesia (epidural) and general anesthesia (none).

Epidural anesthesia

These days, this method of anesthesia is used for up to 95% of cesarean sections performed in Russian maternity hospitals. The basic idea behind the procedure is to introduce a medication through a thin catheter that is inserted into the spine’s epidural space. This medication causes the lower body to become less sensitive to pain.

Such an introduction blocks the passage of nerve impulses through the spinal canal and into the brain. The brain just does not perceive or associate the continuous disruption of tissue integrity during surgery as a cause for activating the pain center when such a "gap" in the CNS chain occurs.

Such anesthesia has a broad range of applications; however, it is thought to be less hazardous when used during a cesarean section or to relieve pain during a natural childbirth than when anesthetizing the cervical spine or arms for upper body procedures.

Anesthesiologists typically use unique, meticulously filtered solutions that were created specifically for this purpose. You can use ropivacaine or lidocaine to ease the pain of a natural childbirth. However, such anesthesia will not be sufficient for a cesarean section. A certain quantity of opiates, such as buprenorphine, morphine, or promedol, can be given in addition to lidocaine. Ketamine usage is common.

The anesthesiologist determines the dosage of drugs based on the patient’s age, weight, and overall health. However, when using spinal anesthesia, opiates are always used in smaller doses than when using intravenous anesthesia, and the effects last longer.

How it is done?

The woman is on her side, shoulders pushed forward, legs slightly tucked in, and only her back visible. To pinpoint the precise location of the catheter insertion, the anesthesiologist employs one of the available techniques. Usually, a syringe attached to the catheter and loaded with air is used for this. The catheter is in the ligamentous space if there is a lot of resistance to the piston. We can then discuss accurately identifying the epidural space, where the drugs should be injected gradually, if resistance is abruptly lost.

There are steps in the introduction. In other words, the doctor administers a test dose initially. Following a three-minute assessment, the remaining portions of the dosage prescribed for that specific woman are injected gradually if the patient exhibits the first indications of anesthesia, such as loss of sensitivity.

A woman can first inquire about the names of the medications that are scheduled to be given by the anesthesiologist, who will undoubtedly meet with her the day before the procedure. However, since the dosage is calculated based on a multitude of factors, it is best to avoid asking about it.

Following total blockage of the lower body, the procedure starts. The woman has a screen placed in front of her face to block her view of the surgeons’ procedures. The woman in labor is able to communicate with the doctors throughout the entire procedure and witness the crucial moment—her baby’s first breath and cry.

The baby may then be left next to the mother for a short while so that she can spend as much time as she wants cuddling with her long-awaited child after the doctors have started to sew the baby.

Pros and cons

While complications following such anesthesia are theoretical, in actual practice they happen in approximately 1 birth out of every 50 thousand. What unanticipated and adverse effects might there be? It is possible for the blockage of nerve endings to not happen, preserving sensitivity; statistically, this occurs in one woman out of every fifty operations. In this instance, the anesthesiologist decides on general anesthesia in a hurry.

A hematoma may form at the site of catheter insertion if the woman has issues clotting blood. It is possible for the anesthesiologist to inadvertently puncture the dura mater during needle insertion, which could result in severe headaches and the leakage of cerebrospinal fluid.

A novice physician’s erroneous motions may cause damage to the subarachnoid space and possibly cause paralysis. Those who oppose general anesthesia argue that while the woman in labor is submerged in a state of total drug-induced sleep during epidural anesthesia, the drugs do not affect the child in any way. This is untrue. Medication used to block pain can lower the baby’s heart rate and put them at risk for hypoxia or respiratory failure after delivery.

Many laboring women experience leg numbness and back pain for some time following surgery. Officially, it is believed that recovering from spinal anesthesia takes roughly two hours. In actuality, the recuperation period is longer.

The woman’s heart and blood vessels remain stable during the procedure, which is one benefit of epidural anesthesia. The fact that not all nerve receptors are blocked is a serious drawback. Although the woman won’t feel pain directly, she will occasionally have to deal with discomfort.

Many women are afraid of this kind of anesthesia because they find it difficult to be present during their own procedure, which scares them more than the potential complications.

Women frequently confuse spinal anesthesia with epidural anesthesia. Since the medication is injected into the back in both situations, the patient actually experiences no difference. However, because spinal anesthesia requires a deeper injection, sensitivity is decreased more successfully.

If the query is basic, make sure to find out if the anesthesiologist intends to inject anesthesia into the subarachnoid or the epidural space of the spine. If not, everything will happen precisely the same way.

General anesthesia

This used to be the only method of pain management for cesarean sections. General anesthesia is being used less and less these days. Officially, this makes sense because general anesthesia is dangerous for both the mother and the child. The Ministry of Health in Russia strongly advises anesthesiologists to make every effort to persuade women to choose regional anesthesia because it is well-known that the cost of medications for spinal or epidural anesthesia is lower. This is a confusing and multifaceted problem.

Endotracheal anesthesia is commonly used for cesarean sections. With it, the woman experiences no sensation, hearing, or vision; she sleeps soundly during the surgical procedure, not worrying herself or posing questions to the medical professionals who assist in bringing her baby into the world.

How it is done?

Such anesthesia requires advance planning. Premedication measures are conducted in the evening on the eve of the scheduled operation day. The woman is prescribed a dose of barbiturates or other strong sedatives prior to bedtime because she needs to unwind and get a good night’s sleep.

The woman receives an atropine dose the following day while in the operating room in order to rule out cardiac arrest during drug-induced slumber. Intravenous analgesics are used to treat pain. At this point, the woman no longer has time to be alarmed by what is happening and drifts off to sleep.

A specialized tube will be placed into her trachea once she has fallen asleep. In order to guarantee pulmonary breathing, intubation is required. Throughout the procedure, the lungs will be supplied with oxygen through the tube along with a mixture of nitrogen and occasionally vapors of narcotics.

The woman in labor will be in a deep sleep, and the anesthesiologist will keep an eye on her condition the entire time, taking her pulse, blood pressure, and other vital signs. The dosages of the support medications given will be changed if needed.

The anesthesiologist starts lowering the dosages of muscle relaxants and anesthetics, which are narcotic substances, shortly before the procedure is about to end, per the surgeon’s orders. Smooth awakening starts when the doses are "zeroed." As one of the first regains the ability to breathe on their own without the use of an artificial lung ventilation apparatus, the tube is now removed from the trachea.

Pros and cons

Regional anesthesia is far less comfortable psychologically than general anesthesia. The conversations between the doctors, which can occasionally shock anyone, are not visible to a woman, and the fact that the patient is laying on the operating table is even more startling. A woman can easily emerge from a state of inhibition and relaxation, but it takes them three to four days to fully recover from anesthesia. The complete cessation of the anesthesia’s effects at all levels of the body’s physiological and biochemical processes is thought to be the ultimate result.

A significant benefit is the total lack of contraindications; that is, this approach is applied to all patients in need of surgical intervention without considering any potential risk factors. Anesthesia is of the highest caliber.

There won’t be any sensations for the woman, neither pleasant nor unpleasant. The development of a specific allergic reaction, laryngospasm, and potential damage to the larynx, tongue, and teeth (during tube insertion and removal) are all potential side effects of endotracheal anesthesia. Following such anesthesia, women frequently experience a sore throat for a few days and a dry cough (which hurts especially when there are new stitches in the abdomen!).

A woman should be aware that she won’t get to meet her child right away if she chooses general anesthesia. Only a few hours later, when she is moved from the intensive care unit—where all laboring women are admitted—to the postpartum ward, will she be able to see the baby.

This problem can, however, sometimes be handled right away; the woman can ask the surgical team to show her the baby as soon as she regains consciousness. Nobody can, however, guarantee that the new mother will recall this particular occasion.

Spinal or epidural anesthesia are usually the most popular options when selecting anesthesia for a cesarean section because they both enable the mother to remain awake and feel little pain. While each method has advantages of its own, spinal anesthesia acts more quickly and completely, whereas epidural pain relief can be modified in real time to provide longer-lasting pain relief. The ideal option will ensure a safe and comfortable experience for mother and child, depending on personal preferences, health conditions, and medical advice.

When the issue is decided only by the doctor?

A woman can let her attending physician know if she is scheduled for a particular kind of anesthesia before her planned cesarean section; the physician will then forward this information to the anesthesiologist. The woman either writes a refusal of regional anesthesia or signs an informed consent form agreeing to epidural anesthesia.

The pregnant woman should not disclose the rationale behind the choice of general anesthesia. She might not even defend her choice to the doctor in a conversation.

By law, general anesthesia is administered to a laboring woman automatically if she writes down her desire for either spinal or epidural anesthesia. Here, a second solution is not possible. However, things may go differently in the opposite scenario, where a woman wishes to be conscious during surgery.

The use of epidural anesthesia is not always appropriate. Furthermore, a woman’s request for the doctor to create an angle in her back prior to surgery will not be granted if:

• there were previous injuries or there are spinal deformities;
• there are signs of inflammation in the area of ​​the proposed needle insertion;
• the woman in labor has low or decreased blood pressure;
• the woman has started bleeding or there is a suspicion of bleeding;
• there is a state of fetal hypoxia.

General anesthesia is thought to be the best option for women with these features.

If the woman has a systemic infection, if the uterus needs to be removed after the baby is extracted (based on indications), or if there is a prolapse of the umbilical cord loops, they will not inquire about the patient’s preference for type of anesthesia. Additionally, these laboring women are given only general anesthesia. Not even other options are taken into account.

Anesthesia Type	Pros and Cons
Spinal Anesthesia	Quick onset, patient awake, lower risk of complications, but may cause headaches after.
Epidural Anesthesia	Allows for extended pain relief, but takes longer to work and can lower blood pressure.
General Anesthesia	Used in emergencies, patient is fully asleep, but higher risk and longer recovery time.

A cesarean section’s appropriate anesthetic depends on a number of variables, such as the mother’s health, the baby’s condition, and the particulars of the procedure. Both spinal and epidural anesthesia are frequently employed and offer advantages of their own.

When a planned C-section is performed, spinal anesthesia is frequently chosen because it relieves pain quickly. Conversely, epidural anesthesia is a good choice in emergency situations because it offers greater flexibility and can be modified during labor.

In the end, you should discuss your options with your physician, who can advise you on the best course of action given your unique situation. The main objective is to put your comfort and safety—as well as the baby’s—first.

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