<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_rjaic-2020-0012_s_006_w2aab3b7b6b1b6b1aab1c15b1Aa"><h3>Objective</h3><p>The choice of anesthesia for emergency cesarean delivery (CD) is one of the most important choices to make in obstetric anesthesia. In this study, we examine which type of anesthesia was used for emergency CD in our hospital, and how the choice affected the time from entry to the operation room until incision (TTI), time until delivery (TTD), and maternal/neonatal outcomes.</p></sec><sec id="j_rjaic-2020-0012_s_007_w2aab3b7b6b1b6b1aab1c15b2Aa"><h3>Methods</h3><p>Retrospectively, we examined all emergency CD’s performed in Shaare Zedek Medical Center between January–December 2018. Results: 1059 patients met the inclusion criteria, of which 7.7% underwent general anesthesia (GA), 36.2% – conversion from labor epidural analgesia to surgical anesthesia, 52% – spinal anesthesia and 4.1% – combined spinal epidural. We did not find a significant difference between the GA and conversion epidural groups in terms of TTI or TTD. Nevertheless, GA was found to be correlated to a high rate of blood-products requirement and ICU admission. The rate of newborns with an APGAR score of less than 7, in both first and fifth second after birth, was significantly higher in the GA group, as well as the need for NICU admission.</p></sec><sec id="j_rjaic-2020-0012_s_008_w2aab3b7b6b1b6b1aab1c15b3Aa"><h3>Conclusion</h3><p>This study clearly emphasizes that the TTI are shortest when using GA or conversion of labor epidural analgesia to surgical anesthesia. Meanwhile, GA is also linked to higher rates of admissions to ICU as well as poorer neonatal outcomes compared to the other groups. Additionally, our study uncovered a low rate of GA, and relatively low rate of regional anesthesia failure, which meets the accepted standards.</p></sec></abstract>

ObjectiveThe choice of anesthesia for emergency cesarean delivery (CD) is one of the most important choices to make in obstetric anesthesia. In this study, we examine which type of anesthesia was used for emergency CD in our hospital, and how the choice affected the time from entry to the operation room until incision (TTI), time until delivery (TTD), and maternal/neonatal outcomes.MethodsRetrospectively, we examined all emergency CD’s performed in Shaare Zedek Medical Center between January–December 2018. Results: 1059 patients met the inclusion criteria, of which 7.7% underwent general anesthesia (GA), 36.2% – conversion from labor epidural analgesia to surgical anesthesia, 52% – spinal anesthesia and 4.1% – combined spinal epidural. We did not find a significant difference between the GA and conversion epidural groups in terms of TTI or TTD. Nevertheless, GA was found to be correlated to a high rate of blood-products requirement and ICU admission. The rate of newborns with an APGAR score of less than 7, in both first and fifth second after birth, was significantly higher in the GA group, as well as the need for NICU admission.ConclusionThis study clearly emphasizes that the TTI are shortest when using GA or conversion of labor epidural analgesia to surgical anesthesia. Meanwhile, GA is also linked to higher rates of admissions to ICU as well as poorer neonatal outcomes compared to the other groups. Additionally, our study uncovered a low rate of GA, and relatively low rate of regional anesthesia failure, which meets the accepted standards.

General versus regional anesthesia for emergency cesarean delivery in a high-volume high-resource referral center: A retrospective cohort study

Romanian Journal of Anaesthesia and Intensive Care

This work is licensed under the Creative Commons Attribution 4.0 International License.

ObjectiveThe choice of anesthesia for emergency cesarean delivery (CD) is one of the most important choices to make in obstetric anesthesia. In this study, we...

	GA	Epidural	Spinal	CSE
Count	79	383	547	16
Mother’s age, Years	31.41 ± 6.76 (19–45)	28.98 ± 6.11 (16–49)	31.83 ± 6.37 (19–52)	32.75 ± 7.61 (20–46)
Parity	4.59 ± 3.52 (1–17)	2.99 ± 2.94 (1–18)	4.43 ± 3.28 (1–19)	4.31 ± 2.44 (1–8)
Past CS	0.59 ± 1.10 (0–5)	0.20 ± 0.41 (0–2)	0.73 ± 1.03 (0–6)	1.69 ± 1.62 (0–5)
Gestational Age, Weeks	36.76 ± 4.26 (26–41)	39.55 ± 1.71 (29–43)	37.53 ± 3.20 (25–42)	37.25 ± 3.02 (30–41)

	GA	Epidural	Spinal	CSE
TTI, Min	11.19 ± 10.74 (0.23–48.48)*	11.29 ± 5.64 (0.68–38.27) NS	19.41 ± 7.77 (0–60.9)	29.94 ± 9.06 (10.22–43.57)
TTD, Min	14.15 ± 11.93 (2.00–53.02)*	16.17 ± 7.55 (2.17–78.77) NS	25.46 ± 9.99 (1–97)	39.09 ± 12.09 (14.22–61.72)
Blood products	9 (11.4%)*	2 (0.5%)	4 (0.7%)	1 (6.3%)
ICU admission	5 (6.3%)*	0 (0%)	1 (0.2%)	0 (0%)

	GA	Epidural	Spinal	CSE
APGAR1 < 7	38 (48.1%)*	63 (16.4%)	87 (15.9%)	3 (18.8%)
APGAR5 < 7	19 (24.1%)*	14 (3.7%)	23 (4.2%)	0 (0%)
Birth Weight	2825 ± 870 (700–4180)	3311 ± 548 (1126–4652)*	2970 ± 783 (570–5114)	2786 ± 667 (1210–3958)
Transfer to NICU	28 (35.4%)*	37 (9.7%)	122 (22.3%)	7 (43.8%)
PH	7.205 ± 0.153 (6.71–7.405)**	7.256 ± 0.094 (6.776–7.442)	7.271 ± 0.975 (6.894–7.506)**	7.22 ± 0.136 (6.895–7.391)

General versus regional anesthesia for emergency cesarean delivery in a high-volume high-resource referral center: A retrospective cohort study

Article Category: Original Paper

Online veröffentlicht: 31. Dez. 2020

Seitenbereich: 6 - 10

DOI: https://doi.org/10.2478/rjaic-2020-0012

Schlüsselwörter
Emergency, cesarean delivery, regional anesthesia, general anesthesia

© 2020 Kenas Wiskott et al.. published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Preoperative Characteristics

Maternal Outcomes

Neonatal Outcomes

General versus regional anesthesia for emergency cesarean delivery in a high-volume high-resource referral center: A retrospective cohort study

Article Category: Original Paper

Online veröffentlicht: 31. Dez. 2020

Seitenbereich: 6 - 10

DOI: https://doi.org/10.2478/rjaic-2020-0012

SchlüsselwörterEmergency, cesarean delivery, regional anesthesia, general anesthesia

© 2020 Kenas Wiskott et al.. published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Preoperative Characteristics

Maternal Outcomes

Neonatal Outcomes

Schlüsselwörter
Emergency, cesarean delivery, regional anesthesia, general anesthesia