REVIEW Southern African Journal of Anaesthesia & Analgesia- February 2004 15 Complications associated with regional anaesthesia for Caesarean section Complications of Regional Anaesthesia for CS

In the public sector most Caesarian Sections are performed using SA. In this setting, epidural anaesthesia for labour is infrequently used, so relatively few epidurals are extended for CS. Both maternal and fetal complications may occur as a con-sequence of the use of RA. These may develop during admin-istration of the RA, intraoperatively or in the postpartum pe-riod. Complications arising during administration of RA: 1. Anxiety related The preparation required for RA is stressful for the patient, and can result in anxiety-related physiological changes. Vas-ovagal episodes are not uncommon and are more severe when the patient is in the sitting than the lateral position. Severe episodes can result in maternal asystole4 and fetal compro-mise.5 Anxiolytic premedication is usually omitted lest it causes neonatal depression, but when the mother is very anx-ious, 1mg of midazolam IV may help prevent vasovagal epi-sodes.6 2. Equipment related Technical problems related to the spinal needle are more frequent when the CSE needle through needle technique is used. If the epidural space is located with a curved Huber tip epidural needle and a fine gauge spinal needle inserted through this, the curve may bend the spinal needle tip result-ing in the inability to withdraw the stylet7, or causing no cere-brospinal fluid (CSF) to flow, due to blockage by the kinked tip.8 Blocked epidural catheters secondary to a defective com-ponent have resulted in technical failure. The obstruction is often located in the catheter connector and remedied simply by changing the connector.9,1