Understanding Anesthesiology - The Global Regional Anesthesia ...

With the patient in left lateral tilt, adequate IV access is
ensured and the monitors are applied. The patient is
prepped and draped prior to induction. After careful
pre-oxygenation, a rapid sequence induction with cricoid
pressure is performed. Generally speaking, no
opioids are administered until delivery of the infant in
order to avoid unnecessary neonatal depression. The
patient is maintained on a 50% mixture of nitrous oxide
and oxygen, and a low dose of volatile agent. The volatile
anesthetics, in higher doses, can decrease uterine
tone, which can lead to increased blood loss. After delivery
of the fetus, a moderate dose of intravenous
opioid is administered. As well, oxytocin is administered
to augment uterine tone. The parturient must be
extubated when fully awake so that intact laryngeal reflexes
will protect against aspiration.
Post-operative pain management in the post-Caesarian
section patient is usually straightforward as the lower
abdominal incision is relatively well-tolerated. In the
instance where intrathecal morphine was administered
to the patient undergoing spinal anesthesia, up to 24
hours of pain relief can be achieved.
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