Publication:

Per-operative anesthetic complications during lower segment caesarean section and their management

Background Lower uterine segment caesarean section (LUCS) is one of the most frequently performed surgical procedures worldwide. Both spinal anesthesia (SA) and general anesthesia (GA) are commonly employed, each carrying a distinct profile of per-operative complications. Prompt recognition and management of these complications, including rare but serious events, are critical for maternal safety. Objective was to determine the frequency, types, and management outcomes of per-operative anesthetic complications during LUCS under spinal and general anesthesia.

Methods A prospective cohort study was conducted at the department of gynecology and obstetrics, Uttara Adhunik Medicak College Hospital, Dhaka, Bangladesh, from January 2025 to December 2025. A total of 163 pregnant women undergoing LUCS were enrolled using purposive sampling. Data on intraoperative complications under SA (n=112) and GA (n=51) were recorded. Management strategies and immediate outcomes were analyzed using SPSS version 23.0.

Results Complications occurred in 48 patients (29.4%). Under SA, hypotension (32.1%), bradycardia (12.5%), and rare complications, including high spinal (1.8%) and transient radicular irritation (0.9%), were observed. Under GA, desaturation (7.8%), failed intubation (3.9%), and one case of anaphylaxis to rocuronium (2.0%) occurred. All complications were managed successfully without maternal mortality.

Conclusions Per-operative anesthetic complications during LUCS are not uncommon. While hypotension under spinal anesthesia predominates, rare complications such as high spinal and anaphylaxis require high vigilance. Protocol-driven management ensures favorable outcomes.