REGIONAL ANAESTHESIA IN OBSTETRICS

Abstract

Background In the past few decades, British epidemiological studies from the fifties made a major contribution to the propagation of regional anaesthesia in obstetrics. They showed the consequence of the complications brought about particularly by GA (difficult intubation/ ventilation/aspiration of gastric content/asphysia) to be the principal cause of anaesthesiarelated death in obstetric population, which is very hard to intubate, statistically 1/250, i. e. ten times the number found in other surgical patients. This is why, in US, for example, more than 84 % of caesarian sections are performed under regional anaesthesia while only the so-called 16 % urgent cases are done in GA. Thus the death rate due to anaesthesia has been reduced and, as the cause of death, anaesthesia has receded to sixth position, after bleeding, pulmonary trombemboly, pre-eclampsia, infections and cardiomiopathies. Subarachnoid anaesthesia, the main method applied in caesarian section, is also, in combination with epidural analgesia (combined subarachnoid-epidural analgesia) the most frequent analgesic method for spontaneus and instrumental vaginal delivery. Conclusions The article describes the specifics of preoperative evaluation for regional anaesthesia in obstetric population. It lists and compares regional anaesthetic/analgesic techniques for caesarian section, spontaneous or instrumental vaginal delivery, the most frequent accompanying phenomena and complications. It makes recommendations related to the prevention and treatment of the latter, types and dosages of local anaesthetics, opiates and their mixtures, and enumerates the ways of maintaining the obstetric analgesia. It also discusses the impact of regional analgesia on labor.