Version July 2025
Neuraxial anesthesia is generally the technique of choice for cesarean delivery. General anesthesia may be indicated in select, limited circumstances.
This algorithm provides an overview of the initial choice of anesthetic technique for cesarean delivery but does not take the place of individual provider clinical judgement. This choice must be individualized, balancing the potential risks to the parturient and to the fetus, and taking into account the parturient's values and preferences. For further information, refer to UpToDate content on anesthesia for cesarean delivery.
CSE: combined spinal-epidural; DPE: dural puncture epidural; MH: malignant hyperthermia.
* The degree of urgency for fetal or maternal issues should be determined in consultation with the obstetrician. In some cases a single shot spinal or rapid extension of a well functioning labor epidural may achieve surgical anesthesia almost as rapidly as induction of general anesthesia.
¶ Severe hypovolemia is a relative contraindication to neuraxial anesthesia due to potential for severe hypotension with onset of neuraxial block.
Δ Coagulopathy is a relative contraindication to neuraxial anesthesia due to risk of spinal epidural hematoma.
◊ Once a labor epidural catheter needs more than one or two unscheduled boluses, it is more likely to fail for surgical anesthesia for cesarean delivery. Poorly functioning epidural catheters should be replaced during labor. If such a catheter is still in place when a cesarean delivery is required, full dose spinal anesthesia should not be performed if there is any evidence of residual epidural block, as high spinal anesthesia may occur and can result in respiratory arrest. Options include:
