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Zalar RW, Quilligan EJ: The influence of scalp sampling on the cesarean section rate for fetal distress. Am J Obstet Gynecol 135:239, 1979
GENERAL PRINCIPLES .s..s...........s....s....s..s... 486 ANALGESIA AND SEDATION DURING LABOR ........ 487
REGIONAL ANALGESIA ..........s...s...s..s..s....s.. 488
SPINAL (SUBARACHNOID) BLOCK .....s............ 490
EPIDURAL ANALGESIA .s...s...s.....s.....s......... 492
LOCAL INFILTRATION FOR CESAREAN DELIVERY ....s. 497
GENERAL ANESTHESIA ......s..............s....s.. 498
POSTPARTUM ANALGESIA .s.......s...s....s....s..s.. 500
We are indebted to Sir James .Simpson, the discoverer of chloroorm, or the introduction of anaesthesia into obstetrical practice. He employed ether or this purpose in 184, and replaced it by chloroorm. Every one agrees as to the marked beneits derived from anaesthesia when operative procedures are to be undertaken, but there is stil considerable dference of opinion as to the advisabiliy of its routine employment in normal labour.
-]. Whitridge Williams (1903)
As cited by Williams, anesthetic techniques were a most welcome addition to obstetrics. That said, obstetrical anesthesia presents unique challenges. Labor begins without warning, and anesthesia may be required within minutes of a full meal. Vomiting with potential aspiration of the gastric contents is a constant threat due to delayed gastric emptying during pregnancy. Disorders of pregnancy such as preeclampsia, placental abruption, or sepsis further compound provision of obstetrical anesthesia.
Of all anesthesia-related deaths in the United States from 1995 to 2005,i3.6 percent were in pregnant women (Li, 2009). Creanga and colleagues (2017) analyzed deaths of women during or within 1 year of pregnancy in the United States from 2011 through 2013. Of these deaths, they found that 3 of 2009 (0.2 percent) were attributable to anesthesia complications. As shown in Table 25-1, between 1979 and 2002, anesthesia-related maternal mortality rates decreased nearly 60 percent, and currently approximately ive deaths per million live births are attributed to anesthesia complications.
About two thirds of deaths associated with general anesthesia are caused by intubation failure or induction problems during cesarean delivery. Deaths associated with regional analgesia are caused by high spinal or epidural blocks-26 percent; respiratory failure-19 percent; and drug reaction-19 percent. he improved case-fatality rate for general anesthesia is especially notable considering that such anesthesia is now used for the highest-risk patients and the most hurried emergencies, that is, decision-to-incision intevals < 15 minutes (Bloom, 2005).
25-1 . Case-Fatality Rates and Rate Ratios of Anesthesia-Related Deaths During Cesarean Delivery by Type of Anesthesia in the United States, ,979-2002 aDeaths per million general or regional anesthetics. (I = confidence interval.
Data from Hawkins, 201s1.