BACKGROUND General anesthesia is feared to have adverse feto-maternal outcomes compared to neuraxial anesthesia. It is recommended to keep rate of caesarean sections under general anesthesia below 5% and 15% for elective and emergency caesarean sections respectively. This study was conducted to find out the prevalence of caesarean sections under general anesthesia at a tertiary care center in western Nepal. METHODS A descriptive cross-sectional study was conducted among caesarean sections conducted at Manipal Teaching Hospital, Pokhara, Nepal from January 2014 to December 2017. Ethical approval was taken from the Institutional Review Committee with reference number MEMG/IRC/GA/122. All the caesarean sections conducted during this study period were included in the study using whole sampling method. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data for each patient was subsequently entered into an Excel spreadsheet and analyzed using Statistical Package for Social Sciences version 20. RESULTS Among 3613 cases, caesarean sections under general anesthesia was observed in 175 (4.84%) in our center over a period of four years at 95% Confidence Interval (4.13-5.55%). The yearly variations ranges from 2.83% to 8.99%. The rate of general anesthesia was found slightly higher in elective 31 (5.82%) as compared to emergency caesarean section 144 (4.67%). CONCLUSIONS The four year medical records of our institution showed fluctuating trend of caesarian sections under general anesthesia. The rate of general anesthesia for emergency caesarian section was within the recommended rate while it was slightly higher in elective caesarian section.