title: Rethinking general anesthesia for cesarean section.
abstract: In this review, we describe the current consensus surrounding general anesthetic management for cesarean section. For induction of anesthesia, rapid-sequence induction using thiopental and suxamethonium has been the recommended standard for a long time. In recent years, induction of anesthesia using propofol, rocuronium, and remifentanil have been gaining popularity. To prevent aspiration pneumonia, a prolonged preoperative fasting and an application of cricoid pressure during induction of anesthesia have been recommended, but these practices may require revision. Guidelines for difficult airway management were developed first in obstetric anesthesia, and the use of a supraglottic airway is now recognized as an effective rescue device. After the delivery of a fetus, switching from volatile anesthetics to intravenous anesthetics has been recommended to avoid uterine atony. At the same time, intraoperative awareness should be avoided. The rate of persistent wound pain is higher when only general anesthesia was used during cesarean section than with regional anesthesia, and thus it is necessary to provide a sufficient postoperative analgesia using multimodal analgesia, including intravenous patient-controlled analgesia (IV-PCA), transversus abdominis plane (TAP) block, non-steroidal inflammatory drugs, and acetaminophen.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Juntendo University, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan. hiroyuki.sumikura@gmail.com.
authors.forename: Hiroyiki
authors.initials: H
authors.lastname: Sumikura
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
authors.forename: Hidetomo
authors.initials: H
authors.lastname: Niwa
authors.affiliation: Department of Anesthesiology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Anesthesiology, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakamoto
authors.affiliation: Department of Anesthesiology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Asai
authors.affiliation: Department of Anesthesiology, Osaka University, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hagihira
mesh_terms: D016058:Analgesia, Patient-Controlled / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D058926:Intraoperative Awareness; D010149:Postoperative Pain / Q000188:drug therapy; D011247:Pregnancy
chemical_list: D018686:Anesthetics, Intravenous
keywords: Airway management; Cesarean section; Intraoperative awareness; Rapid-sequence induction