Anesthetic and Perioperative Considerations for Cesarean Delivery

Anesthetic Management

The American College of Obstetricians and Gynecologists recommends the use of regional anesthesia (epidural or spinal) as the preferred method for cesarean delivery as part of an enhanced recovery protocol 1
There are no specific contraindications for the use of regional anesthesia in patients treated with levotiroxina, according to the American Journal of Obstetrics and Gynecology 1, 2

A multimodal approach to postoperative pain management is recommended, including paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) initiated intraoperatively, as suggested by Anaesthesia 2, 3
Intrathecal morphine at a dose of 50-100 μg or diamorphine up to 300 μg may be used for postoperative pain management, as recommended by Anaesthesia 2, 4

Maintaining normothermia during cesarean delivery is important and can be achieved through forced-air warming, warming of intravenous fluids, and increasing the operating room temperature, as recommended by the American Journal of Obstetrics and Gynecology 1
Thromboprophylaxis is recommended for patients with additional risk factors for venous thromboembolism (VTE), according to Chest and the American Journal of Obstetrics and Gynecology 3, 5

A regular diet is recommended within 2 hours after cesarean delivery, as suggested by the American Journal of Obstetrics and Gynecology 3
Early mobilization after cesarean delivery is recommended, as advised by the American Journal of Obstetrics and Gynecology 3

Delayed cord clamping for at least 1 minute is recommended for term births, as suggested by the American Journal of Obstetrics and Gynecology 1
The newborn's body temperature should be measured and maintained between 36.5°C and 37.5°C after birth, as recommended by the American Journal of Obstetrics and Gynecology 1

The American College of Obstetricians and Gynecologists suggests that deriphylline, a theophylline derivative bronchodilator, can interact with multiple medications commonly used in the perioperative period, which may complicate the postoperative recovery 6
The Anaesthesia journal recommends caution when prescribing levocetirizine in the immediate postoperative period, as the sedative effects may impair ambulation and maternal care of the newborn 7
The American Journal of Obstetrics and Gynecology advises monitoring for cardiovascular effects and drug interactions when deriphylline is prescribed, and ensuring patient hydration and mobilization 6

The Anaesthesia journal recommends a multimodal analgesia regimen for post-cesarean care, including intravenous dexamethasone for both analgesia and antiemetic effects 6
The American Journal of Obstetrics and Gynecology suggests that the established multimodal analgesia regimen for post-cesarean care includes paracetamol, NSAIDs, and intrathecal morphine, with consideration of deriphylline and levocetirizine for specific indications 6, 7

The Anaesthesia journal recommends assessing the severity of sedation risk versus benefit of symptom control when considering antihistamine use for allergic symptoms 7
The American Journal of Obstetrics and Gynecology advises evaluating the necessity of deriphylline versus alternative therapies for respiratory symptoms, and monitoring for cardiovascular effects and drug interactions 6