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This article closes the series of review articles Current practices in obstetric anaesthesia. The main objective of this part is to emphasize the fundamental importance of adequate analgesia, early mobilization and early oral intake for patients undergoing caesarean section as an important element to reduce the overall postoperative morbidity. [ABSTRACT FROM AUTHOR]

Aim: The aim of the national survey was to describe current anaesthesia practice for minor surgery in the early postpartum period in the Czech Republic (CZE). Type of the study: National prospective observational survey. Setting: 49 obstetric departments in CZE. Methods: We aimed to enrol all the 97 obstetric departments in CZE and to monitor every case of peripartum anaesthetic care during November 2011. Data were recorded to Case Report Form with two parts (Demography 2010 and Case Report) into TrialDB database (Yale University, USA; adapted IBA, MU, CZE). The data were presented descriptively with Statistica 10 software. Results: We enrolled 1940 cases of anaesthesiological care from 49 participating centres, and 142 (7.3%) of the cases were during the postpartum period. The most common procedure was manual removal of the placenta (106, 74.6%), instrumental revision of the uterus (56, 39.4%) and repair of postpartum injury (47, 33.1%). General anaesthesia was most commonly used (131, 92.3%), the rest of the cases were in epidural anaesthesia (11, 7.7%). Airway was secured mainly with face mask (88, 67.2%) or orotracheal tube (27, 20.6%). If the patient was intubated, rapid sequence induction (24, 88.9%) with cricoid pressure (15, 55.6%) and suxamethonium (27, 100%) were used in most cases. General anaesthesia was induced with propofol (108, 82.4%) followed by ketamine (33, 25.2%) and thiopentone (12, 9.2%). Intra-operative analgesia was provided by sufentanil (55, 42.0%), alfentanil (28, 21.4%) or fentanyl (16, 12.2%). Conclusion: There is a trend to use general anaesthesia with face mask and propofol for minor surgery in the postpartum period in the CZE. [ABSTRACT FROM AUTHOR]

Postdural puncture headache (PDPH) is a relatively common iatrogenic complication (about 1% of all neuroaxial punctures) in obstetrics. The reasons for higher incidence in pregnant women compared to the general patient population are mainly the physiological and pathophysiological differences in pregnant women, but also the increasing number of neuroaxial blockades used. Because untreated postdural puncture syndrome can result in fatal complications, the basic principle of treatment is a complex multimodal approach consisting of all available conservative and invasive therapies, adequate communication and psychological support of the patient. The aim of this article is to provide an overview and current views on the pathophysiology and treatment of this complication. [ABSTRACT FROM AUTHOR]

The objective of this communication is to show the existence of complications in caesarean section specifically associated with the application and maintenance of anaesthesia. Despite the obvious benefits of neuroaxial forms of anaesthesia for caesarean section general anaesthesia still has its place in the delivery room and is associated with risk of difficult airways management. For epidural anaesthesia total spinal anaesthesia remains the most feared complication. Spinal anaesthesia is associated with mother hypotension and the hypoperfusion of fetoplacental unit. Most of the expected complications of anaesthesia in caesarean section are effectively preventable. The good clinical outcome both for mother and newborn depends on right decision and adequacy of therapy. [ABSTRACT FROM AUTHOR]

Nearly a quarter of all births in the Czech Republic end by caesarean section in the recent years. With the increasing age of mothers, number of comorbidities, deliveries after previous caesarean section and many other causes, it can be assumed that this trend will continue to rise despite all the efforts to change it. This negative trend is also influenced by the decreasing willingness of obstetricians to "risk" spontaneous labour in borderline obstetric situations. The growing number of caesarean sections increases the importance and influence of anaesthesia. As well as elsewhere in the world, we register the rise of regional anaesthesia in comparison to general anaesthesia in the past 20 years, so at present regional anaesthesia in caesarean delivery prevails. A review of the actual numbers however shows the alarming gap between the Czech Republic and the rest of the world. In 2011 regional anaesthesia for caesarean section was administered in 53% of cases and general anaesthesia in 47% in the Czech Republic. For comparison, general anaesthesia for caesarean section does not exceed 10--15% in most of the developed world. The causes include the conservatism of Czech obstetrics and the reluctance of obstetricians in many departments to regional anaesthesia techniques, but perhaps also the lack of availability of "local" experiences published in the Czech medical journals. Therefore ESPAA in this article aims to summarize the current experience and recommendations for caesarean section under regional anesthesia to support the sites where some concerns to regional techniques still remain. [ABSTRACT FROM AUTHOR]

The aim of the following series of articles about Caesarean Section is to provide a contemporary view of the most important procedures in anaesthesia for Caesarean Section and to open up some as yet possibly controversial topics. This review is based mainly on the current literature and summarizes the consensus views of Expert Group for Obstetric Anaesthesia and Analgesia (ESPA), who work as an expert committee of CSARIM. One of the main ESPA's goals is the presentation and moderation of current topics in obstetric anaesthesia in Anesteziologie & intenzivni medicina, the most read medical Czech journal of our specialty. The first step then is this four-part series „Current practice in obstetric anaesthesia" with the objective to summarize current trends, and also to comment and 'translate' the contents to the Czech hospital environment and practice. In this first part the topics of choice are anaesthesia for Caesarean delivery, oxygen therapy, thromboprophylaxis, hypotension, severe hypertension and administration of oxytocin. [ABSTRACT FROM AUTHOR]

Spinal hematoma (SH) after neuraxial puncture is considered the most serious complication of regional anaesthesia. The risk is further significantly increased by co-administration of thromboprophylaxis with low molecular weight heparins (LMWH). In the 1990s, the risk of SH on the basis of published case reports was estimated as 1 : 1 000 000. These estimates are now closer to 1 : 3 000. Concomitant application of LMWH is responsible for such a dramatic increase of the risk of SH, especially in orthopaedics. Therefore, a number of anaesthesiology societies have adopted a recommendation concerning the time relation between the administration of neuraxial anaesthesia and LMWH applications. Generally, the risks are only approximated for the low incidence of SH, and for pregnant women this risk is estimated between 1 : 200 000 and 1 : 400 000. If there is an increased risk of SH with concomitant LMWH in orthopaedic patients, in the case of obstetric anaesthesia this increased risk is very questionable. So far there has not been a single published case report giving the context of SH and LMWH use in pregnancy, which, in addition to the physiological hypercoagulable state, differs in altered pharmacokinetics and pharmacodynamics of LMWH. The following text attempts to summarize the current information available regarding the relation of thromboprophylaxis and the risk of spinal hematoma in obstetrics. [ABSTRACT FROM AUTHOR]