Abstract:
Background: Globally obstetric anesthesia is being done under spinal and epidural than general anesthesia (GA) for most caesarean sections (CSs). This is because GA is associated with failed endotracheal
intubation and aspiration of gastric contents. Eventhough general anesthesia is the fastest method for
anesthetizing a category 1 cesarean section, it is associated with increased maternal mortality and
morbidity. Spinal anesthesia is the preferred regional technique for cesarean section but failure sometimes occurs. To minimize the time factor of spinal anesthesia as well as to avoid the side effects of
general anesthesia ‘rapid sequence spinal ‘(RSS) has developed as a novel approach in cases of category
one cesarean sections.
Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database
and Google Scholars were used to find high-level evidences that help to draw appropriate conclusions.
Discussion: Neuraxial anesthetic techniques have several advantages which include low risk of aspiration
and failed intubation, avoidance of central nervous system (CNS) and respiratory depressant drugs, the
ability to maintain a wakeful state of mother enjoying the experience of delivery of baby and also lower
incidence of blood loss. ‘Rapid sequence spinal’ described to minimize anesthetic time. This consists of a
no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts,
allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anesthesia if there are delays or problems. To do rapid sequence spinal anesthesia
safely and timely, cooperative work is mandatory with good team relation for those simultaneous and
necessary tasks.
Conclusion: The choice of anesthetic in Cesarean section has long been recognized as one of prime
importance, because there are two lives to safeguard instead of one. A balance must be struck between
the anesthetic dictated by the general condition of the mother and that suited to the needs of the fetal
respiratory system.
