Anesthesia for Operative Caesarean Section Delivery

A comprehensive search for guidelines was done to identify the most relevant ones to consider for adaptation. For the literature review, potentially relevant clinical studies were identified via electronic and manual searches of the literature. The updated searches covered a 15-year period from January 1, 2010, to July 31, 2025. The inclusion/exclusion criteria that were followed in the search and retrieval of guidelines are adapted.

➡️We selected guidelines only if they are:

-  Evidence-based guidelines.

- National and/or international guidelines.

-  Guidelines published from 2010 to 2025.

-  Peer reviewed publications.

-  Guidelines written in English language.

➡️We Excluded guidelines that are:

-Written by a single author not on behalf of an organization as guideline to be valid and comprehensive, ideally requires multidisciplinary input.

-Published without references as the panel needs to know whether a thorough literature review was conducted and whether the current evidence was used in the preparation of the recommendations.

All retrieved Guidelines were screened and appraised using AGREE II instrument (www.agreetrust.org) by at least three members of the GDG. The panel decided on a cut-off point or ranked the guidelines (any guideline scoring above 50% on the rigor dimension was retained).

➡️Guidelines used in the Adaptation Process:

The basic elements of the international guidelines for the anesthetic management in obstetrics published by international societies can be successfully implemented in the practice of obstetric anesthesiologists worldwide. The Guidelines Development Group (GDG) for the Egyptian Board of Anesthetics, Surgical Intensive Care, and Pain Management has adopted with modification:

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. Approved by the ASA House of Delegates on October 28, 2015. Anesthesiology Feb 2016; 124(2):270–300. (Reference No. 1)

2.      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 (Reference No. 57)

3.      Statement on Pain During Cesarean Delivery. Developed by: Committee on Obstetric Anesthesia. Original Approval: October 18, 2023. (Reference No. 62)

4.      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. (Reference No. 64)

5.      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). (Reference No. 40)

6.      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. (Reference No. 18)

7.      Society for Obstetric Anesthesia and Perinatology (SOAP) Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients With Thrombocytopenia (SOAP Thrombocytopenia Consensus Statement March 2021. (Reference No. 41)

8.      American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019 Mar;133(3):e208–e225. ACOG(Reference No. 66)

9.      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) (Reference No. 19)

10.   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. (Reference No. 76)

➡️Strength of Recommendations

The strength of a recommendation communicates the importance of adherence to the recommendation.