Anaesthetic management in emergency cesarean section: Systematic literature review of anaesthetic techniques for emergency C-section

The literature related with the anesthetic management of emergent C section is limited, for which reasonwe proposed the systematic evaluation of the existing literature on anesthetic management of obstetric patients undergoing emergency cesarean section in order to define the most appropriate interventions based on evidence. A systematic review of the literature was undertaken in MEDLINE, 1966 to December 2010, Cochrane Collaboration registry of clinical trials, Cochrane systematic review database, and LILACS. The study selection process was undertaken independently by two researcher-reviewers, who identified controlled clinical trials and cohort studies of anaesthetic management in emergency C-section. The data were extracted, reviewed and subjected to quality evaluation in duplicate fashion. In total, 2,297, 36, 221were examined, respectively, and of those 16 potentially relevant papers, 9 clinical trials and 7 observational studies were included in the study. A heterogeneity analysis was done using I2, with a result of 52%, and for this reason no meta-analysiswas conducted. Conclusions: The anaesthetist plays a critical part in mother-and-child care, prioritization of the C-section urgency, peridural anaesthesia extension with 2% lidocaine plus adjuvants (fentanyl plus fresh adrenaline), the use of vasopressors (phenylephrine, ephedrine) for the aggressive management of hypotension, the use of oxygen supplementation and the adequate management of general anaesthesia when indicated, contributing to a favourable impact on the outcome for both the mother and the baby. Long-term neonatal outcomes are not influenced by the type of anaesthesia given to the mother.