Anesthesia for cesarean section
The past decade has witnessed a series of major changes in the practice of obstetrics, including a three-to fourfold increase in the incidence of delivery by cesarean section. At the same time, obstetric anesthesia has emerged as a recognized subspecialty of anesthesiology, with increasing attention focused on measuring the impacts on mother, fetus, and newborn of anesthetic interventions. The present review indicates substantial advances in our understanding of the physiology, pharmacology and clinical management of anesthesia for cesarean delivery. At the same time, the need for further studies is clear, particularly in the areas of prevention of the risks of gastric aspiration, management of patients with hypertension and diabetes, and the short- and long-term effects of analgesics and anesthetics on the premature, the compromised, and the full-term fetus and infant. Excellent results are obtained in elective cesarean section at term with well-managed spinal, epidural, or general anesthesia. 245 references are cited.