Clinical practice of obstetric anesthesia: neuraxial techniques, general anesthesia and maternal safety

Abstract

Obstetric anesthesia is a specialized field that integrates labor analgesia, anesthesia for cesarean delivery, and emergency peripartum care. Contemporary practice favors neuraxial techniques because they provide effective analgesia, avoid airway manipulation, and are associated with lower maternal morbidity and mortality compared with general anesthesia in many obstetric settings. Epidural analgesia remains the standard method for labor pain relief and can be titrated continuously while preserving maternal participation and minimizing dense motor block. Spinal anesthesia is commonly used for elective cesarean delivery because of its rapid onset, reliability, and dense surgical block, whereas combined spinal-epidural techniques provide both rapid onset and catheter-based flexibility. General anesthesia remains essential for selected emergencies, particularly Category 1 cesarean delivery when fetal or maternal compromise prevents timely regional anesthesia, but it carries higher risks of failed intubation, aspiration, awareness, and neonatal drug exposure. Safe obstetric anesthesia requires individualized technique selection, anticipation of maternal comorbidities, preparation for hemorrhage and failed airway, appropriate vasopressor use, and multidisciplinary crisis response. This review summarizes the clinical practice of obstetric anesthesia, emphasizing the rationale for neuraxial preference, the persistent role of general anesthesia, and practical considerations for maternal and neonatal safety.