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Cesarian Section General versus Regional Anesthesia

Cesarian Section General versus Regional Anesthesia. Presented by: Tareq Salwati SSC-Anaes Department of Anesthesiology Maternity and Childrens ’ s Hospital Jarwal, The Holy Capital. Why do we need cesarian sections?. Why do we need cesarian sections:.

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Cesarian Section General versus Regional Anesthesia

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  1. Cesarian SectionGeneral versus Regional Anesthesia Presented by: Tareq Salwati SSC-Anaes Department of Anesthesiology Maternity and Childrens’s Hospital Jarwal, The Holy Capital

  2. Why do we need cesarian sections?

  3. Why do we need cesarian sections: To prevent maternal and foetal morbidity and mortality

  4. Examples for Indications for Cesarian Sections:Labor unsafe for mother and fetus: Increased risk of uterine rupture Previous classic cesarean section Previous extensive myomectomy or uterine reconstruction

  5. Examples for Indications for Cesarian Sections:Labor unsafe for mother and fetus: Increased risk of maternal hemorrhage Central or partial placenta previa Abruptio placentae Previous vaginal reconstruction

  6. Examples for Indications for Cesarian Sections:Dystocia Abnormal fetopelvic relations Fetopelvic disproportion Abnormal fetal presentation Transverse or oblique lie Breech presentation Dysfunctional uterine activity

  7. Examples for Indications for Cesarian Sections:Immediate or emergent delivery necessary Fetal distress Umbilical cord prolapse Maternal hemorrhage Amnionitis Genital herpes with ruptured membranes Impending maternal death

  8. Why do we need anesthesia for cesarian section?

  9. Why do we need anesthesia for cesarian section? It would be otherwise extremely painful for the mother !!!

  10. Choices of Anesthesia available:

  11. Choices of Anesthesia available: General anesthesia

  12. Choices of Anesthesia available: General anesthesia Regional anesthesia

  13. Choices of Anesthesia available: General anesthesia Regional anesthesia Local anesthesia

  14. General anesthesia

  15. General anesthesia Advantages:

  16. General anesthesiaAdvantages: Rapid onset

  17. General anesthesiaAdvantages: Controlled airway and ventilation

  18. General anesthesiaAdvantages: Anesthetist's hands are free for fluid management and hemodynamics control in cases of major bleeding.(that is, the airway is already secured)

  19. General anesthesiaAdvantages: Almost never fails

  20. General anesthesiaAdvantages: Minimal cooperation needed from the patient (possibly only to insert canula and tolerate a face mask).

  21. General Anesthesia Disadvantages:

  22. General AnesthesiaDisadvantages: 16 X higher anesthesia related mortality compared to regional anesthesia.

  23. General AnesthesiaDisadvantages: Risk of difficult/failed intubation

  24. General AnesthesiaDisadvantages: Risk of difficult/failed intubation Risk of failed intubation in parturients is 10 X higher than in non-obstetric population.

  25. General AnesthesiaDisadvantages: Risk of pulmunary aspiration

  26. General AnesthesiaDisadvantages: Contributes to uterine relaxation/atony

  27. General AnesthesiaDisadvantages: Extra time needed at end of procedure to wake up the the patient

  28. General AnesthesiaDisadvantages: Usually faster onset of postoperative pain

  29. General AnesthesiaDisadvantages: Risk of Malignant hyperthermia

  30. General AnesthesiaDisadvantages: Mother and child deprived from early bonding

  31. General AnesthesiaDisadvantages: Risk of intaoperative awareness under anesthesia (higher risk than general population)

  32. General AnesthesiaDisadvantages: Exposure of fetus to depressant effect of general anesthetics

  33. General AnesthesiaDisadvantages: When you face an unexpected difficult intubation in a case of a really urgent cesarian, then everybody in the theater is in big stress.

  34. General AnesthesiaDisadvantages: Risk of broken teeth.

  35. General AnesthesiaDisadvantages: Sore throat postoperatively due to the endotrachial tube.

  36. General AnesthesiaDisadvantages: More costly (costs more money $$$).

  37. Most important causes of mortality due to General anesthesia: Inability to intubate Inability to ventilate Aspiration pneumonitis

  38. Regional anesthesia

  39. Regional anesthesia Advantages:

  40. Regional anesthesiaAdvantages: Anesthesia related mortality much lower than general anesthesia.

  41. Regional anesthesiaAdvantages: No need for intubation

  42. Regional anesthesiaAdvantages: No difficult/failed intubation

  43. Regional anesthesiaAdvantages: Less risk of pulmunary aspiration

  44. Regional anesthesiaAdvantages: Awake mother when the baby is born.

  45. Regional anesthesiaAdvantages: Early bonding of mother and child.

  46. Regional anesthesiaAdvantages: Mothers are often very happy when shown their baby while they did not notice that the surgery has even yet started!!

  47. Regional anesthesiaAdvantages: Almost no exposure of fetus to anesthetic drugs.

  48. Regional anesthesiaAdvantages: No contribution to uterine relaxation/atony.

  49. Regional anesthesiaAdvantages: No time needed at end of the procedure to wake up the patient, thus immediately ready to leave to recovery room.

  50. Regional Anesthesia Disadvantages

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