Anaesthetic Options for LSCS
Vaginal delivery is recommended whenever possible (with a good regional block and an assisted second stage); caesarean is for obstetric indications or decompensated disease. The choice below is for when LSCS is planned.
๐ข Graded epidural (preferred)
- Slow, titrated epidural โ the total dose is titrated to the desired level, so the fall in SVR/preload is gradual and controllable.
- Best tolerated in NYHA IโII (mildโmoderate) MS; slower onset is an advantage here.
๐ด Single-shot spinal (avoided)
- A single-shot spinal is avoided โ the sudden fall in SVR & preload and the reflex tachycardia are poorly tolerated by a fixed valve.
๐ต General anaesthesia
- For NYHA IIIโIV, decompensated disease, or when regional is contraindicated.
- Attenuate the laryngoscopy/intubation pressor response โ opioids (remifentanil/fentanyl) ยฑ ฮฒ-blocker; modified RSI using etomidate + remifentanil + suxamethonium; avoid tachycardia and light planes; ensure adequate depth.
- Disadvantages of GA: haemodynamic swings, positive-pressure ventilation worsening a high PVR/PAH. Advantages: airway control, TEE available, opioid-based technique is cardiostable with excellent analgesia; avoid large doses of volatile; avoid NโO in severe PAH (use 50:50 Oโ:NโO only if PAH mild).