Anesthesia for Operative Caesarean Section Delivery
- REFERENCES
1. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016;124(2):270–300. https://doi.org/10.1097/ALN.0000000000000935
2. Royal College of Obstetricians and Gynecologists (RCOG) (2010). Classification of urgency of cesarean section - NICE/RCOG consensus. https://www.rcog.org.uk/
3. National Institute for Health and Care Excellence (NICE) Guidelines (UK) – Caesarean Birth. Reference number: NG192. Published on 31 March 2021 and last updated on 10 June 2025.
4. Apfelbaum JL et al. (2016). Practice guidelines for obstetric anesthesia. Anesthesiology, 124(2), 270–300.
5. National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. NICE guideline [NG133]. London: NICE; 2023 Jun [updated 2023 Jun; cited 2024 Month Day]. Available from: https://www.nice.org.uk/guidance/ng133
6. Yonghui Xu , Sha Zhu , Hao Song , Xiaoyuan Lian , Maoni Zeng , Ji He , Lijuan Shu , Xing Sheng Xue , Fei Xiao. A new modified obstetric early warning score for prognostication of severe maternal morbidity BMC Pregnancy Childbirth. 2022 Dec 5;22(1):901. doi: 10.1186/s12884-022-05216-7.
7. Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists’ Association . Difficult Airway Society, Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015. November;70(11):1286–306. 10.1111/anae.13260 [DOI] [PMC free article] [PubMed] [Google Scholar]
8. Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, et al. Canadian Airway Focus Group . Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: Part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth. 2021. September;68(9):1373–404. 10.1007/s12630-021-02007-0 [DOI] [PMC free article] [PubMed] [Google Scholar
9. Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018. May 15;5(5):CD008874. 10.1002/14651858.CD008874.pub2 [DOI] [PMC free article] [PubMed] [Google Scholar
10. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022. American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022. January 1;136(1):31–81. 10.1097/ALN.0000000000004002 [DOI] [PubMed] [Google Scholar
11. Statement on Neuraxial Analgesia or Anesthesia in Obstetrics. Developed By: Committee on Obstetrics and Anesthesia. Last Amended: October 13, 2021 (original approval: October 12, 1988)
12. Woldeamanuel GG, Tlaye KG, Ling Wu, Wang CC. Platelet count in preeclampsia: a systematic review and meta-analysis. AJOG MFM Systematic Review Volume 5, Issue 7100979July 2023
13. Manchanda J, MalikA. Study of platelet indices in pregnancy-induced hypertension. Med J Armed Forces India. 2019;76(2):161–165. doi: 10.1016/j.mjafi.2019.02.006
14. Perez ER, Gutierrez JJP, Avella-Molano B. Fetal heart rate changes and labor neuraxial analgesia: a machine learning approach. BMC pregnancy and Childbirth, 2023;23(1) DOI:10.1186/s12884-023-05632-3
15. Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, et al. American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular Update of the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting, Anesthesiology Feb 2023 1;138(2):132-151.
16. National Institute for Health and Care Excellence (NICE) Guidelines. Perioperative care in adults. Reference number:NG180. Published: 19 August 2020. nice.org.uk.
17. Morrison CE , Ritchie-McLean S, Jha A, and Monty Mythen M. Two hours too long: time to review fasting guidelines for clear fluids. British Journal of Anaesthesia, 2020; 124 (4): 363e366
18. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: An updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting. ANESTHESIOLOGY 2011; 114:495–511.
19.
Statement on Optimal
Goals for Anesthesia Care in Obstetrics. American Society of
Anesthesiologists. Developed By: Committee on Obstetrics and Anesthesia
Last
amended October 13, 2021 (original approval: October 17, 2007)
20. American Society of Anesthesiologists (ASA) Standards for Basic Anesthetic Monitoring. published by the ASA Committee on Standards and Practice Parameters. The most recent version of the standards is from 2020.
21. World Federation of Societies of Anesthesiologists (WFSA) – International Standards for a Safe Practice of Anesthesia (2022)
22. Association of Anaesthetists, Royal College of Anaesthetists, and Association of Pediatric Anaesthetists. (2021) Safety Guideline: Checking Anaesthetic Equipment. London: Association of Anaesthetists.
23. Royal College of Obstetricians and Gynecologists (RCOG). "Safer Childbirth: Minimum Standards for the Organization and Delivery of Care in Labor" (2007)
24. Association of Anaesthetists (AoA) – Guidelines for the Safe Management of Anaesthetic Drugs (AoA, 2016)
25. Difficult Airway Society 2025. guidelines for management of the unanticipated difficult airway in adults, published in the British Journal of Anaesthesia on November 6, 2025. Article in Press
26. World Health Organization (WHO) Surgical Safety Checklist – Feb 4, 2016. Emergency preparedness element. WHO Safe surgery website.
27. David H. Chestnut et al. Chestnut’s Obstetric Anesthesia: Principles and Practice" –ISBN-10. 032356688X ; ISBN-13. 978-0323566889 ; Edition. 6th ; Publisher. Elsevier ; Publication date. April 17, 2019.
28. Habib AS. Choice of anesthesia for cesarean delivery. Anesthesiol Clin. 2013;31(1):1-17.
29. American Society of Anesthesiologists (ASA) Practice Guidelines for Obstetric Anesthesia, 2020 by L Bollag — Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia
30. Cochrane Review: "Regional versus general anesthesia for cesarean section" by Afolabi BB and Lesi FEA was published in 2021 as Issue 11, Article Number CD004350, with DOI 10.1002/14651858.CD004350.pub3. Available on the Cochrane Library website.
31. Practice Bulletins from the American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics
32. Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. Curr Anesthesiol Rep 2021;11:18-27
33. SJS Bajwa SJS 2013 — Preload or coload for spinal anesthesia for elective cesarean delivery: A meta-analysis. Can J Anaesth. 2010;57:24–31. doi: 10.1007/s12630-009-9206-7. [DOI]
34. Jacob JJ, Williams A, Verghese M, Afzal L: Crystalloid preload versus crystalloid coload for parturients undergoing cesarean section under spinal anaesthesia. J Obstet Anaesth Crit Care 2012; 2:10–15
35. International Consensus Statement on Management of Hypotension at Caesarean Section (Anaesthesia 2018)
36. Rosen, M. A., et al. (2013). "The effect of phenylephrine and ephedrine on maternal hemodynamics and fetal acid-base status in women undergoing neuraxial anesthesia." Anesthesiology, 118(6), 1239-1245.
37. Ngan Kee, W. D., et al. (2010). "Comparison of phenylephrine and ephedrine for the management of hypotension during spinal anesthesia for caesarean delivery: a systematic review and meta-analysis." British Journal of Anaesthesia, 105(3), 309-318.
38. Parker, J. M., et al. (2020). "Opioid use after Caesarean delivery: A comparison of regional versus parenteral analgesia." Journal of Obstetric Anesthesia.
39. McCaffrey, J. H., et al. (2016). "Effectiveness of intrathecal opioids for post-cesarean analgesia: A systematic review and meta-analysis." Canadian Journal of Anesthesia.
40. Society for Obstetric Anesthesia and Perinatology (SOAP) Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia (SOAP Thrombocytopenia Consensus Statement March 2021.
41. Statement on Neuraxial Analgesia or Anesthesia in Obstetrics. Committee of Origin: Obstetric Anesthesia (Approved by the ASA House of Delegates on October 12, 1988, and last amended on October 13, 2021).
42. NYSORA (New York School of Regional Anesthesia). Benzon HT, Jabri RS, and Van Zundert TC Neuraxial Anesthesia and Peripheral Nerve Blocks in Patients on Anticoagulants.
43. Sia, A. T. H., Tan, K. H., Sng, B. L., Lim, Y., Ocampo, C. E. (2010). The optimal maternal position for epidural analgesia: A randomized comparison of sitting and lateral positions. Anesthesia & Analgesia, 110(1), 191–196.
44. Zhao X, He L, Xu H. Pencil-point spinal needles reduce the incidence of postdural puncture headache: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2012;56(6):702–711.
45. Koh DCT, Leong SM, Tan GMY, Sia ATH. Pencil-point spinal needles and postdural puncture headache: a randomized trial comparing needle types in obstetric patients. Br J Anaesth. 2013;111(4):591–597.
46. American Society of Regional Anesthesia and Pain Medicine (ASRA) Evidence-Based Guidelines: Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy (Fourth Edition). Reg Anesth Pain Med. 2018;43(3):263-309.
47. Nixon, L. M., & Bucklin, B. A. (2015). "Anesthesia for cesarean delivery: An update." Current Opinion in Anesthesiology, 28(3), 215-220.
48. Palazzo, S. A., & Williams, S. J. (2018). "Guidelines for assessing spinal and epidural anesthesia." Journal of Clinical Anesthesia, 49, 12-18.
49. Vila, H., & Rawal, N. Regional Anesthesia for Caesarean Section: A Review of the Literature. Acta Anaesthesiologica Scandinavica, 2012; 56(6): 683-694.
50. Myles, P. S., & Leslie, K. Anesthesia for Caesarean Section: Current Perspectives and Recommendations. Canadian Journal of Anesthesia 2020; 57(3): 201–213.
51. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43(3):263–309.
52. European Society of Anaesthesiology (ESA) guidelines on perioperative venous thromboembolism prophylaxis. The primary reference for this is the 2018 publication in the European Journal of Anaesthesiology, updated in 2024.
53. Royal College of Obstetricians and Gynecologists (RCOG) Green-top Guideline No. 37a. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. RCOG April 2015 (amended 2023)
54. National Institute for Health and Care Excellence (NICE) Guidelines – Antenatal care [N] Risk factors for venous thromboembolism in pregnancy NICE guideline NG201 Evidence reviews underpinning recommendations 1.2.19, 1.2.21 and 1.2.22 August 2021
55. Royal College of Obstetricians and Gynecologists (RCOG) guidelines on thromboprophylaxis in pregnancy is Green-top Guideline No. 37a: Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium, published in April 2015 and amended in 2023, available on the RCOG website.
56. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 232 on "Prevention of Venous Thromboembolism in Gynecologic Surgery" and ACOG Practice Bulletin No. 196 on "Thromboembolism in Pregnancy".
57. Guidelines to the Practice of Anesthesia, Revised Edition 2025, Canadian Journal of Anesthesia, Volume 72, number 1 Can J Anesth/J Can Anesth https://doi.org/10.1007/s12630-024-02906-y.
58. Michael C. Plewa; Walter A. Hall; Russell K. McAllister. Postdural Puncture Headache. National Library of Medicine. Last Update: February 15, 2025. https://www.ncbi.nlm.nih.gov/books/NBK430925/
59. Obstetric Anesthetists Association. Treatment of obstetric post-dural puncture headache: Executive summary of recommendations. 2018. Accessed May 25, 2021.
60. Statement on Post-Dural Puncture Headache Management Committee of Origin: Obstetric Anesthesia (Approved by the ASA House of Delegates on October 13, 2021).
61. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010 Jul-Aug;50(7):1144-52.
62. Statement on Pain During Cesarean Delivery. Developed by: Committee on Obstetric Anesthesia. Original Approval: October 18, 2023.
63. Obstetric Anaesthetists' Association, Association of Anaesthetists of Great Britain & Ireland. OAA/AAGBI Guidelines – Obstetric Anaesthesia Guidelines. London. R Russel and N Lucasa 2014. International Journal of Obstetric Anesthesia (IJOA) Editorial Volume 23, Issue 2p101-105May 2014. https://www.obstetanesthesia.com › article › abstract.
64. Statement on the Use of Adjuvant Medications and Management of Intraoperative Pain During Caesarean Delivery. Developed by: Committee on Obstetric Anesthesia. Original Approval: October 23, 2024.
65. Kang H, Lim T, Lee HJ, Kim TW, Kim W, Chang HW. Comparison of the effect of dexmedetomidine and midazolam under spinal anesthesia for cesarean delivery: a randomized controlled trial, single-center study in South Korea. Anesth Pain Med (Seoul) 2023;18:159-168
66. American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019 Mar;133(3):e208–e225. ACOG
67. Behdad S, Hajiesmaeili MR, Abbasi HR, Ayatollahi V, Khadiv Z, Sedaghat A. Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial. Anesth Pain Med 2013;3:230-233.
68. World Health Organization. WHO Surgical Safety Checklist (First Edition). Geneva: World Health Organization; 2009. Available as part of the WHO Safe Surgery Saves Lives program.
69. National Institute for Health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NICE Guideline NG89). London: NICE; 2018 Mar (last updated 13 August 2019). ISBN 978-1-4731-2871-2.
70. Royal College of Obstetricians and Gynecologists. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. Green-top Guideline No. 37a. London: RCOG; April 2015.
71. American College of Obstetricians and Gynecologists (ACOG). Committee Opinion No. 742: Postpartum Pain Management, published in Obstetrics & Gynecology, July 2018, with revisions in 2021 to incorporate new evidence.
72. Smith V, Barry C, Flynn A, Higgins D, Zerbetto R, Cavalerio CCS, Feeley C, Begley C. Complementary and alternative therapies for post‐caesarean pain. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD011216. DOI: 10.1002/14651858.CD011216.pub2
73. Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022. American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022. January 1;136(1):31–81. 10.1097/ALN.0000000000004002 [DOI] [PubMed] [Google Scholar
74. Eale SC, Bauer ME, Klumpner TT, Aziz MF, Fields KG, Hurwitz R, Saad M, Kheterpal S, Bateman BT: Frequency and Risk Factors for Difficult Intubation in Women Undergoing General Anesthesia for Cesarean Delivery: A Multicenter Retrospective Cohort Analysis. Anesthesiology 2022 May 1;136(5):697-708
75. Metodiev Y, Mushambi M: The role of supraglottic airway devices in obstetric anesthesia. Curr Opin Anaesthesiol. 2023 Jun 1;36(3):276-280.
76. Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2022; 118:251–70.
77. Mushambi MC, Kinsella SM, Popat M, Swales H, Ramaswamy KK, Winton AL, et al. Obstetric Anaesthetists’ Association . Difficult Airway Society. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia. 2015. November;70(11):1286–306.
78. Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, et al. Canadian Airway Focus Group . Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: Part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth. 2021. September;68(9):1373–404.
79. European Resuscitation Council (ERC) Guidelines 2025 on Cardiopulmonary Resuscitation. The guidelines for cardiac arrest in pregnant women in "Cardiac arrest in special circumstances".
80. The American Heart Association (AHA) Guidelines "Cardiac Arrest in Pregnancy" scientific statement published in Circulation in 2015, and updated in the 2025 guidelines.
81. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (18 suppl 3): S640-933
82. American Society of Regional Anesthesia and Pain Medicine (ASRA). Checklist for Local Anesthetic Systemic Toxicity (LAST) Management. ASRA Pain Medicine website.
83. Neal JM, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: 2017. Reg Anesth Pain Med. 2018;43(2):113-123. [PMID: 29324509]
84. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016. V 124. N 2.
85. World Health Organization. Consolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage / WHO recommendations on TXA and uterotonics. (WHO publications, 2012–2023 updates). World Health Organization+1
86. Royal College of Obstetricians and Gynecologists (RCOG) / Blood transfusion guidance: Blood Transfusion in Obstetrics (RCOG GTG/related publications) —(Green-top Guideline No. 47). guidance on FFP, cryoprecipitate, fibrinogen and platelet thresholds. first published in May 2015, with updates in 2016. rcog.org.uk
Royal College of Obstetricians and Gynecologists. Prevention and Management of Postpartum Haemorrhage (Green-top Guideline No. 52). 2016/2017. Available online. rcog.org.uk+1