Patient positioning, prepping, and draping
Chapter 15 discusses in detail the operating room preparation of the patient. The patient is placed in the decubitus position. A left or right lateral tilt may be required if the patient develops hypotension from caval compression. The dorsolithotomy position is chosen in selected cases to avoid an anterior placenta and if no access from the right or the left side of the patient is available. A Foley catheter is placed in the bladder. The patient is then fully prepped and draped as for any major surgery.
Anesthesia
Chapter 18 discusses in detail our experience with general and local anesthesia. Most centers today use local anesthesia in the form of 1% lidocaine without epinephrine. A 10 ml syringe with a 21-gauge 11/2 inch needle is used. The skin is infiltrated to create a wheal. The needle is then inserted under ultrasound guidance to infiltrate the tissues to the level of the uterine serosa.
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