Anaesthesia for Caesarean Section 1. Introduction This text outlines the types of Anaesthesia available for a Caesarean Section. Your Anaesthesiologists will assess you prior to your Caesarean and discuss your anaesthetic with you in more detail. You can also obtain more information from your Obstetrician, Midwife and Antenatal classes. 2. Who administers anaesthesia for Caesarean Sections? Anaesthesia for Caesarean Section in Union Hospital is administered by Anaesthesiologists. They are Medical Practitioners who have had a minimum of 6 years further Specialist Training in Anaesthesia following their medical degree. 3. Types of Anaesthesia for Caesarean Section There are four types of Anaesthesia available for Caesarean section: Spinal Anaesthesia Epidural Anaesthesia Combined Spinal/ Epidural Anaesthesia General Anaesthesia   In Union Hospital , most cases are done under Spinal Anaesthesia or General Anaesthesia, as compared to Epidural. This is because it: is quicker and possibly cheaper is easier is less painful uses a lower dose of local anaesthetic and produces a more reliable block Spinal Anaesthesia (SA) allows the mother to be awake during the delivery of the baby by Caesarean Section. Local Anaesthetic solutions are administered into the spinal fluid (Spinal Anaesthetic). This causes loss of sensation up to the level of the breasts and loss of movement in the legs during the Caesarean Section. The partner/husband can be present at the delivery with epidural or spinal anaesthesia, unless it is during off-office hours. The baby is usually more alert at delivery after this form of anaesthesia, compared to General Anaesthesia. Currently most women and anaesthesiologists choose to have this form of Anaesthesia. General anaesthesia (GA) is also occasionally used for Caesarean Section. With GA you have intravenous drugs to induce you to sleep and you are kept asleep with a combination of Anaesthetic gases and intra-venous drugs. There are some Medical or Obstetric conditions where General Anaesthesia is preferable but generally, Spinal Anaesthesia is the preferred option because it is safer. Epidural or combined Spinal/Epidural Anaesthesia is mostly used for labour pain during normal spontaneous delivery in Union Hospital & seldom used in the operating theatre. There may be special clinical conditions where this is preferred and your Anaesthesiologist will discuss with you should this option be deemed best for you. 4. Pre-anaesthetic Consultation Your Anaesthesiologist will assess you prior to your Caesarean Section and discuss your Anaesthetic with you. This will generally occur on the day of your Caesarean Section. You may see your Anaesthesiologist prior to this if you have had previous Anaesthetic problems, Medical problems or if you have specific issues you would like to discuss. You can arrange this by asking your Obstetrician to do so. 5. Side Effects more common with GA for Caesarean Section Regurgitation and Inhalation of Gastric Contents Pregnant women are more prone to gastric reflux. This means women having Caesarean Section require techniques to minimize the risk of inhaling gastric contents. These include antacid medication given before the operation and protecting the airway with a tube in the trachea during the anaesthetic. The universal use of these preventive measures and increased awareness of the safety of Spinal Anesthesia have markedly reduced the incidence of this serious problem. This is one prime reason for the almost universal shift from General Anaesthesia for Caesarean Section to Spinal Anaesthesia in the world. Difficult Airway Pregnancy can cause difficulties in managing the airway in women. Your Anaesthetist will assess your airway prior to Anaesthesia. Some women will require epidural or spinal anaesthesia if difficulty in managing the airway is anticipated. In these situations Anaesthesiologist use their expert airway management skills to secure an airway. Awareness of Surgery In the past General Anaesthesia for Caesarean Section was quite "light" because there was a fear that "heavy" anaesthesia would harm the baby. We now know that babies can tolerate the effect of anaesthetic delivered to the mother at Caesarean Section, consequently higher doses of anaesthetic drugs and anaesthetic gases are administered to the mother with a very much lesser risk of "awareness" of surgery with little risk to the baby. 6. What to expect during Spinal Anaesthesia for Caesarean Section Awareness of surgery All women having epidural or Spinal Anaesthesia for Caesarean Section will feel some movement, tugging and pulling. For most women there will not be discomfort associated with these sensations. It is important to be aware that these sensations do not mean you will feel pain. Discomfort or Pain during surgery Some women will feel discomfort or pain and may need medication through their intravenous line to control this. About 1 in 200 women will require General Anaesthesia if their discomfort cannot be controlled. It is important to advise your Anaesthesiologist if there is any discomfort and they will assess you and the stage of the operation and decide how best to manage this. Spinal Headache As with epidurals in childbirth both epidural and spinal anaesthesia for Caesarean section have a risk of causing a spinal headache. This is a headache due to leakage of spinal fluid which may occur if the epidural needle causes an accidental "dural tap" or if there is a spinal fluid leak after a Spinal Anaesthetic. The needle used for Spinal Anaesthesia is very fine and has a special tip designed to minimize spinal headache. The chance of a severe spinal headache is similar with both Spinal and Epidural Anaesthesia and is approximately 1 in 100 . 7. Pain Relief following Anaesthesia Pain relief medications can be given via rectal, intravenous, and oral routes. Side effects of include: nausea, drowsiness or itchiness. These side effects will be treated as they occur.