ПРИПРЕМА НА ПАЦИЕНТИ И ИЗБОР НА АНЕСТЕЗИЈА ПРИ ИТЕН И ПЛАНИРАН ЦАРСКИ РЕЗ
PREPARATION OF PATIENTS AND CHOISE OF ANESTHESIA IN EMERGENCY AND PLANNED CAESAREAN SECTION

Summary/Abstract: Caesarean section represents one of the most frequently performed surgical procedures in modern obstetrics, with its incidence showing a continuous global increase. This procedure, which can be life-threatening, carries specific risks for both the mother and the newborn; therefore, proper preoperative preparation and the appropriate choice of anesthesia play a crucial role in ensuring an optimal clinical outcome. The aim of this paper is to analyze the principles and protocols for preparing the patient for both planned and emergency caesarean section. The paper covers contemporary recommendations for preoperative assessment, including medical history, laboratory analyses, as well as evaluation of anesthesiological risk according to the ASA classification. Regarding anesthesia, the paper examines the advantages and disadvantages of different anesthetic approaches. Regional (spinal) anesthesia is highlighted as the method of choice for planned caesarean section due to its better safety profile, lower risk of complications, and the possibility of early interaction between the mother and the newborn. In contrast, general anesthesia plays a significant role in emergency caesarean section when rapid intervention is required or when there are contraindications to regional anesthesia. The performance of the technique for administering regional anesthesia requires adherence to general rules. Every anesthesiologist is obliged to prepare the patient for anesthesia and the surgical procedure. Preoperative premedication should also be given, if the caesarean section is planned, in order to reduce the patient’s feeling of fear. Some patients easily accept regional anesthesia, while others do not want to know what is happening during the surgical procedure and request general anesthesia. Before the start of the intervention, it is necessary for the anesthesiologist to visit the patient and take a medical history regarding their physical and psychological condition. This includes a detailed examination of the patient, reviewing the available results, and making a decision about the choice of anesthesia. In addition to obtaining information from the patient, at the same time the patient gains trust and receives information from the anesthesiologist about the type of anesthesia, the method of its administration, as well as possible complications. Continuous communication among the team during the performance of a caesarean section is essential in order to determine whether the fetus, the mother, or both are in immediate danger, and accordingly decide whether general anesthesia is required or if there is sufficient time to safely perform regional anesthesia. The successful performance of a caesarean section depends on timely and adequate preparation of the patient, the appropriate choice of anesthesia, and the coordinated work of the entire medical team. The implementation of modern protocols significantly improves outcomes for both the mother and the newborn.

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