Unplanned cesarean section in parturients with an epidural catheter in-situ: how to obtain surgical anesthesia?

Epidural analgesia is frequently used for labor. Several authors advocate its use when parturient women are at increased risk for emergency Cesarean delivery. Hereby, the time needed to achieve adequate surgical anesthesia may be shortened and general anesthesia may be avoided. Starting from epidural labor analgesia, the most predominant anesthetic technique for unplanned Cesarean surgery is to top-up the existing epidural catheter. Little consensus can be found in literature about the nature of local anesthetic solution to be used to provide rapid onset and high quality anesthesia for the entire duration of surgery. Women, whose epidural analgesia extension fails either receive a new neuraxial blockade, or receive general anesthesia. We reviewed the medical literature to better define the best methods and choice of products at providing a rapid and adequate surgical anesthesia in parturient women with an epidural catheter in-situ.