Canis ISSN: 2398-2942

Anesthesia: for Cesarean section

Contributor(s): Marieke de Vries, Sheilah Robertson

Introduction

  • Survival rates of 3410 puppies out of 808 dams undergoing Cesarean section (58% on emergency basis):
    • 92% immediately following delivery.
    • 87% at 2 hours.
    • 80% at 7 days.
  • Maternal mortality was 1%, of which 56% was attributed to pneumonia, for which aspiration Lung: aspiration pneumonia was the very likely cause.
  • Increased likelihood of all puppies surviving following delivery was found when:
    • Surgery was not an emergency.
    • The dam was not a brachycephalic breed.
    • The litter consisted of a maximum of 4 puppies.
    • No puppies were delivered naturally.
    • No puppies were deformed.
    • All puppies were breathing spontaneously at birth.
    • At least one puppy vocalized spontaneously at birth.
    • No xylazine was administered.
  • Most major body systems undergo changes during pregnancy, which may have a significant impact on anesthetic management. The anesthetic technique chosen should ideally provide optimal maternal and fetal conditions to ensure optimal oxygen delivery with minimal neurological and cardiorespiratory depression of both the dam and puppies.

Aims

  • Safety of the mother should be first priority.
  • Good levels of arterial oxygen tension and optimal placental blood flow.
  • Good abdominal relaxation during surgery.
  • Production of viable, well-oxygenated neonates with minimal respiratory depression.
  • Rapid recovery from anesthesia, including good analgesia, to minimize disruption in the ability of the dam to care for the new-borns.
  • The most important factors to consider when deciding upon the anesthetic protocol are:
    • The health status of the dam.
    • The viability of the puppies.
    • Emergency vs. 'elective' procedure.
    • Provision of analgesia to the dam.
    • Familiarity with the anesthetic technique.
    • Available drugs.
  • Epidural anesthesia Epidural analgesia technique alone is not a viable alternative to general anesthesia General anesthesia: overview , as heavy sedation Sedation / sedative protocols is necessary to ensure a compliant patient. This may have more detrimental effects on the fetus(es) than a well administered general anesthetic. However, lumbar epidural analgesia/anesthesia providing both analgesia and relaxation of abdominal skeletal musculature may enable an absolute minimum of inhalational maintenance agent to be used, thus reducing the inevitable cardiovascular and respiratory system depression produced by the general anesthetic agent to a minimum.

Physiology of pregnancy

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Pre-anesthetic considerations

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Sedation/preanesthetic medication

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Anesthesia

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Analgesia

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Brodbelt D (2009) Perioperative mortality in small animal anaesthesia. The Veterinary Journal 182 (2), 152-161 PubMed.
  • Mathews K A (2005) Analgesia for the pregnant, lactating and neonatal to pediatric cat and dog. JVECC 15 (4), 273-284 VetMedResource.
  • Luna S P L, Cassu R N, Castro G B et al (2004) Effects of four anaesthetic protocols on the neurological and cardiorespiratory variables of puppies born by caesarean section. Vet Rec 154 (13), 387-389 PubMed.
  • Moon-Massat P F & Erb H N (2002) Perioperative factors associated with puppy vigor after delivery by cesarean section. JAAHA 38 (1), 90-96 PubMed.
  • Moon P F, Erb H N, Ludders J W et al (2002) Perioperative risk factors for puppies delivered by cesarean section in the United States and Canada. J Am Anim Hosp Assoc 36 (4), 359-368 PubMed.
  • Moon P F, Erb H N, Ludders J W et al (1998) Perioperative management and mortality rates of dogs undergoing cesarean section in the United States and Canada. Am Vet Med Assoc 213 (3), 365-369 PubMed.
  • Probst C W, Broadstone R V & Evans A T (1987) Postural influence on systemic blood pressure in large full-term bitches during general anesthesia. Vet Surg 16 (6), 471-473 PubMed.
  • Probst C W, Webb A I (1983) Postural influence on systemic blood pressure, gas exchange, and acid/base status in the term-pregnant bitch during general anesthesia. Am J Vet Res 44 (10), 1963-1965 PubMed.

Other sources of information

  • Clarke K W & Trim C M (2014) Anaesthesia for Obstetrics. In: Veterinary Anaesthesia, 11th ed., Ed. Clarke KW, Trim CM and Hall LW. Saunders Elsevier Oxford, UK. Chapter 19, pp 594-596.
  • Dugdale A (2010) Pregnancy and Caesarean Sections. In: Veterinary Anaesthesia, Principles to Practice.1st ed., Wiley-Blackwell, Oxford, UK. Chapter 39, pp 318-321.
  • Robertson S A (2010) Physiology of pregnancy and anesthesia for cesarean section in dogs. www.IVIS.org, proceedings of the SEVC Southern European Veterinary Conference, Oct 2-4, Barcelona, Spain.
  • Kutzler M A (2009) Dystocia and obstetric crises. In: Small Animal Critical Care Medicine1st ed. pp 611-615.
  • Metcalfe S, Hulands-Nave A, Bell M, Kidd C, Pasloske K & O'Hagan B (2008) A multi-centre clinical trial evaluating the efficacy and safety of Alfaxan® administered to bitches for induction of anaesthesia prior to caesarean section. Abstract provided by Jurox Pty Ltd. and presented at ISCFR (Vienna) and WASVA (Dublin).
  • Meyer R E (2007) Caesarean Section. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia. 2nd ed., Eds: Seymour C and Duke - Novakovski T. British Small Animal Veterinary Association, Gloucester, UK. Chapter 24, pp 265- 273.
  • Raffe M R & Carpenter R E (2007) Anesthetic management of cesarean section patients. In: Lumb & Jones' Veterinary Anesthesia and Analgesia 4th ed. pp 955-967.


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