While regional anesthesia or general anesthesia are both acceptable for cesarean delivery , the use of general anesthesia has fallen dramatically in the past few decades and is now used in less than 5 percent of cesarean deliveries in the United States and United Kingdom .
This topic reviews anesthetic issues specific to the planning and management of anesthesia for cesarean delivery. Management of anesthesia in pregnant patients and airway management of pregnant patients are discussed separately. (See "Management of the pregnant patient undergoing nonobstetric surgery" and "Airway management of the pregnant patient at delivery".)
PLANNING THE ANESTHETIC APPROACH
The anesthetic plan for cesarean delivery must take into account the wellbeing of two patients: the mother and the fetus.
Preanesthetic evaluation — Planning for anesthesia in pregnant patients must consider the physiologic changes of pregnancy and the status of the fetus. The preanesthetic evaluation is similar to that for other preoperative patients, with a focus on assessment of the airway, lower back, and coexisting maternal medical conditions. It is reasonable to schedule a preadmission consultation with an anesthesiologist for patients at risk of complications during labor and delivery and those with procedure-related risks, even if they are not planning an anesthetic (table 1). Laboratory testing is discussed separately. (See "Management of the pregnant patient undergoing nonobstetric surgery", section on 'Physiological changes related to pregnancy' and "Cesarean delivery: Preoperative issues", section on 'Laboratory testing'.)
Rationale for neuraxial anesthesia — Neuraxial anesthesia is the most common anesthetic technique, used for over 95 percent of planned cesarean deliveries in the United States . The preference for neuraxial techniques in most cases is based on a desire to avoid general anesthesia for delivery, because of: