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Anesthesia for Elective Cesarean Delivery
Neuraxial-first technique, aspiration prophylaxis, left uterine displacement, and uterotonic management
Scheduled cesarean delivery under neuraxial anesthesia (spinal preferred) with T4 block, left uterine displacement, standard ASA monitors, aspiration prophylaxis, prophylactic antibiotics, and postpartum uterotonics.
If you forget
Neuraxial > GA — individualize for urgency, maternal/fetal status, comorbidities, and existing neuraxial access (ASA 2016)
Board trap
Why must a cesarean block reach T4 and not T10? — Visceral afferents from the uterus enter at T10-L1, but peritoneal traction and uterine exteriorization require cephalad coverage to T4 to prevent visceral pain, retching, and sympathetic response during surgery.
Key numbers
- Spinal: hyperbaric bupivacaine 0.5% 12-15 mg intrathecal
- Target sensory level: T4 (nipple line)
- Left uterine displacement: ≥15° from 20 weeks gestation
- Oxytocin: 10-40 U in 1 L NS after delivery; avoid undiluted bolus
- Cefazolin: 2 g IV (3 g if weight >120 kg) within 60 min of incision
- Phenylephrine: 50-100 mcg IV bolus, repeat for spinal hypotension
Reviewed Sep 15, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: ASA Obstetric Anesthesia 2016 · ACOG Pb222 Hypertension Pregnancy 2020
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: elective-cesarean · Path: aba.ob.cesarean.elective-cesarean