Obstetric anaesthesia: Is there anything new under the sun?

Abstract

Recent years have seen considerable sophistication in the practice of obstetric anaesthesia in the developed world. Important areas include regional anaesthesia in labour, regional anaesthesia for caesarean section (CS), categorization of the urgency of CS, and clearer definition of fetal indications for CS. The physiological basis for management of spinal hypotension is now well understood. Regional anaesthesia for patients with preeclampsia is established, and is rapidly developing in those with cardiac co-morbidities. Maternal awareness during general anaesthesia for CS has been considerably reduced. A better understanding of the pharmacology of oxytocic drugs has facilitated the management of obstetric haemorrhage. However, anaesthesia-related maternal morbidity and mortality in South Africa remains unacceptably high, and a major effort, including the development of a Special Interest Group, is necessary to address the specific problems in obstetric anaesthesia in our country.