Anesthesia for cesarean section
Preoperative evaluation
Performing a maternal evaluation and obtaining surgical consent are essential before the anesthesia provider administers anesthesia for a C/S. Along with performing a standard preoperative maternal evaluation, including a focused history and physical examination, the anesthesia provider should also ascertain information regarding fetal gestation and pregnancy-related complications. Laboratory studies are obtained as maternal comorbid conditions and the planned procedure dictate; however, a blood sample for type and screen or crossmatch is often standard for multiparous women or for parturients with other common physiologic alterations. Preparation for elective, urgent, and emergent C/S includes aspiration prophylaxis and establishment of adequate venous access (Box 186-1).
Regional anesthesia
Subarachnoid block and epidural anesthesia are recommended for elective C/S. When compared with general anesthesia, these techniques provide excellent anesthesia, prevent fetal depression and maternal airway management difficulties, and do not place the mother at risk for aspirating gastric contents. Local anesthetic agents, with or without the addition of an opioid, may be used for either a subarachnoid block (Table 186-1) or an epidural anesthetic (Table 186-2).
Table 186-1
Drugs Used for Subarachnoid Block for Cesarean Section
| Drug | Dose |
| Bupivacaine | 7.5-15 mg |
| Lidocaine* | 60-80 mg |
| Levobupivacaine | 7.5-15 mg |
| Ropivacaine | 15-25 mg |
| Fentanyl | 10-25 μg |
| Morphine | 0.1-0.2 mg |
