Anesthesia in obstetrics includes the medical attendance of women in the delivery room as well as giving
anesthesia for
cesarean sections in the operating room. Over the last years the treatment of
labor pain with
epidural anesthesia has been modified. Whereas a couple of years ago
local anesthetics were used almost exclusively, the recent trend goes toward a combination of
local anesthetics with
opioids. Using this combination the total amount of
local anesthetic can be greatly reduced, whilst maintaining most of the motor function during labor. There is evidence the combination of
local anesthetics with
opioids can reduce the number of operative vaginal deliveries such as vacuum extraction or
forceps. The systemic application of
opioids remains unaffected by the local application and its significance is unaltered, even though the effectiveness compared to epidural application in managing
labor pain is far inferior.
Opioids applied systemically often have an unwanted
sedative effect in the mother and have the potential for
respiratory depression in the newborn. The question, whether
epidural anesthesia increases the frequency of
cesarean sections remains to be answered. Studies so far present discrepant results and do not show a causal relationship between the use of
epidural anesthesia and increase in
cesarean section rate. Regarding
cesarean sections, there has been a trend in the operative field over the last years towards the use of
regional anesthesia. This is the consequence of the fact that
anesthesia related mortality during
cesarean sections is still mainly due to
hypoxia and aspiration during induction of
anesthesia. The advantage of
spinal anesthesia over
epidural anesthesia is faster onset, more reliable sensitive block and a lower failure rate. Downside of the use of
spinal anesthesia is a higher incidence of
hypotension in the mother, which, however, is not a serious complication if treated adequately. Regarding the continuous application of
local anesthetics via a spinal
catheter, no definite statements towards benefits compared to other regional techniques can be made due to the lack of adequate amount of patient studies. Theoretically this method seems advantageous as it allows to adjust the administration of
local anesthetics and
opioids to the individual needs in a very refined way. Emergency situations, such as emergency
cesarean sections, life threatening
hemorrhage,
eclampsia, and
HELLP syndrome, are the main risks of the
anesthetic practice in obstetrics. Their beneficial outcome is highly dependent on the coordination of logistic problems, good communication and coordination within an interdisciplinary team of obstetricians and anesthesiologists.