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General anaesthesia for caesarean section


J.W. Downing
A.J. Coleman
M.C. Mahomedy
D.E. Jeal
Y.H. Mahomedy

Abstract

The special problems confronting the obstetric anaesthetist are emphasised. The anaesthetic sequence currently used in over 2 000 caesarean sections performed yearly at King Edward VIII Hospital, Durban, is described. The importance of lateral tilt, the length of induction to delivery (1-0 interval), and the time taken from uterine incision to delivery of the fetus (U-D interval) are discussed. The various manoeuvres employed to protect the mother from the hazards of pulmonary aspiration of acid gastric contents, are reviewed. The problem of maternal awareness during surgery, and its avoidance by the use of various supple'mentary anaesthetic agents, is considered. Drug-induced neonatal depression associated with anaesthesia should be avoided, and induction agents which adversely affect the maternal haemodynamics should not be used in the patient suffering from hypovolaemic or septic shock. The rare occurrence of laryngeal oedema in the obstetric patient and its management, is discussed in relation to the anaesthetic technique advocated.

S. Afr. Med. J., 48, 1497 (1974).

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eISSN: 2078-5135
print ISSN: 0256-9574