More than half of canine cesarean sections in the United States and Canada are emergency procedures, and puppy mortality is 12.7% compared with 3.6% mortality in elective procedures, suggesting that the mother's status before surgery impacts the outcome. Mortality in both dogs and humans has been linked with specific anesthetic techniques. Proper anesthetic management can improve survival for cesarean patients and their offspring, and evaluation for expediting surgery is desirable. Changes in the cardiovascular, respiratory, central nervous, and gastrointestinal systems during pregnancy are reviewed, because such changes affect selection of anesthesia protocols, perioperative monitoring, support, pain management, and intervention for complications to protect the mother and unborn pups. Recommendations for patient preparation, compensation for fluid loss with appropriate hydration, preoxygenation, warming of mother and pups during and after the procedure, and postdelivery neonatal care are discussed along with a complete rundown of preferred techniques, anesthetics, and pain medications and dosages.

COMMENTARY: This detailed update discusses best practices for cesarean patients. Clinicians do not often perform cesareans; this article provides an in-depth and succinct overview of the latest management techniques, anesthetics, and pain medications for the best possible outcome in patients and their pups to guide the practitioner.

Anesthetic management for cesarean section in bitches. Robertson SA, Moon PF. VET MED: 675-696, 2003.