[Choice of anesthesia procedure in cesarean section (general versus regional)]

Peripartum maternal mortality occurs in about 0.2% of patients. There are anaesthesiological causes in 5%-15%. Almost 50% of the anaesthesiologically based fatalities can be attributed to aspiration and hypoxia, frequently in combination with problems of intubation during general anaesthesia. In spite of numerous recommendations to avoid aspiration, it will never be possible to prevent hypoxaemia once and for all. In order to do as much as possible to exclude this maternal risk during a caesarean section, regional anaesthesia is being performed more often. Appropriate techniques are: lumbar (catheter), epidural, or spinal anaesthesia. Because of the large dose of the local anaesthetic necessary, caudal anaesthesia is normally excluded. The advantage of these techniques, especially with relation to the safety of the mother, can only be guaranteed for the following prerequisites: when maternal hypotension can be excluded or treated in time; when the block inadvertently spreads too high and is diagnosed in time; when intravascular injection of the local anaesthetic is avoided. Regional anaesthesia techniques do not endanger the cardiocirculation of the fetus, or its respiration, metabolism or neurological adaptability. Furthermore, these techniques are more advantageous when the developmental period is prolonged. The use of long-acting local anaesthetics is beneficial, as only a small quantity passes through the placenta and mixture with adrenaline is avoided. This is important because adrenaline may jeopardize the perfusion of the pregnant uterus because of the increased sensitivity of its alpha-receptors. For epidural anaesthesia, 0.75% bupivacaine is most frequently administered on account of the rapid onset of action and enhanced motor block.(ABSTRACT TRUNCATED AT 250 WORDS)