الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The use of general anesthesia is challenged in developed countries because of increased obesity and cardiovascular diseases, but currently this is also becoming a problem in developing countries like our country, even with significant effect due to poor set up for managing, so revising our anesthetic practice is vital to decrease maternal morbidity and mortality in an attempt to meet the millennium development goals.
In addition to better neonatal and maternal out comes, regional anesthesia is associated with less cost to the hospital, less charge to the patient and better client satisfaction to the service due to good post-operative analgesia without additional analgesics
The main cause of maternal hypotension during SA for cesarean section is peripheral vasodilation, and it has been reported that the degree of decrease of BP and systemic vascular resistance depend on the dose of local anesthetic.
Identification of patients at risk of hypotension is important for anesthesia management for maternal and fetal safety. Prophylaxis of maternal hypotension has been investigated in numerous studies. Various fluid protocols have reduce but not prevent hypotension, hence the importance of early administration of vasopressor.
Hypotension causes problems for the mother and fetus, including nausea, vomiting, dizziness and fetal acidemia. Therefore, prediction and prevention of maternal hypotension are potentially important.
Several advantages of spinal anesthesia include a decreased incidence of deep vein thrombosis, reduced intraoperative blood loss, as well as the prevention of pulmonary aspiration in case of emergency, especially in patients with potential airway problems and known respiratory diseases. Proper patient selection, meticulous attention to detail, well-known patient related changes will minimize the post spinal complication , using image techniques [x rays, fluoroscopy and ultrasound] as a guide may help to prevent or decrease complications.
Norepinephrine is as effective as phenylephrine in preventing spinal hypotension but has less adverse effects on HR and greater CO compared with phenylephrine during caesarean section. Further work is needed to confirm the safety and efficacy of norepinephrine in obstetric patients.