• Preoperative evaluation of the airway (inability to intubate is the leading cause of maternal death related to anesthesia)
• Premedication with 15–30 mL of a nonparticulate antacid within 30 minutes of induction
• The parturient should be maintained in the left uterine displacement position while on the operating table
• Preoxygenation
• A defasciculating dose of nondepolarizing muscle relaxant is not necessary
• 4 mg/kg IV of thiopental (2 mg/kg of propofol or 0.5 mg/kg IV of ketamine) plus 1–1.5 mg/kg IV of succinylcholine should be used during cricoid pressure (drugs should be injected at the onset of contraction if the patient is in labor)
• Skin incision should be done after confirmation of tracheal tube placement
• Rocuronium (0.6 mg/kg IV) is an acceptable alternative when succinylcholine is contraindicated
• An LMA should be considered if tracheal intubation cannot be accomplished
• In the interval between intubation and delivery, anesthesia is maintained with a 50:50 mixture of nitrous oxide in oxygen and a volatile anesthetic agent (use greater concentrations than 0.5 MAC to avoid awareness)
• Extreme hyperventilation of the lungs should be avoided because it may reduce uterine blood flow
• Oxytocin is added to the infusion after delivery, and anesthesia is deepened (possibly with opioids)
• The trachea is extubated when the patient awakens

IV = intravenous; LMA = laryngeal mask airway; MAC = minimum alveolar concentration.