///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Response times and perinatal outcomes for crash cesarean sections at Kandang Kerbau Hospital (KKH), Singapore and the effect of anesthetic technique

Abstract Number: 159
Abstract Type: Original Research

Mukesh Shah MBBS (Malaya), M.Med(Anaes) (NUS)1 ; Yvonne Lim MBBS, M.Med(Anaes)2

Introduction: In 1995, the Royal College of Obstetricians and Gynaecologists (RCOG) proposed that there be an arbitrary maximum decision-to-delivery (neonate) interval (DDI) of 30 minutes for urgent cesarean sections (CS). In 1997, our tertiary maternity hospital, KKH, established a protocol for crash (i.e. extremely urgent) CS to expedite delivery time.

Methods: To evaluate the effectiveness of the protocol, we conducted, following institutional review board approval, a 12-month audit (from February 2003 to January 2004) of the anesthesia and surgical response times and perinatal outcomes at our institution.

Results: Out of 3,629 elective and non-elective CS, there were 98 cases of crash CS (2.7 %). 18 audit forms did not indicate the time of activation of crash CS, so time intervals from these forms were not calculated. For the 80 cases with complete data, the decision-to-anesthesia interval (DAI) (mean SD) was 3.5 2.0 min with all patients anesthetized within 10 minutes, the decision-to-incision interval (DII) was 5.2 2.3 min, and the DDI was 7.7 3.0 minutes, with all deliveries within 17 minutes. The 5-minute Apgar score, median(range), was 9 (2-9) while the neonatal cord blood pH was 7.23 0.09. The majority (71 parturients, 88.75 %) had general anesthesia (GA) while the remaining nine parturients had successful epidural anesthesia extension (EA). Labor epidurals were in-situ in 25 parturients. EA was attempted in 13 but only nine had timely successful extension. The DAI was 3.6 2.1 min in the GA group and 3.2 0.8 min in the EA group (p = 0.63). The DII was 5.1 2.4 min in the GA group and 5.7 1.1 min in the EA group (p = 0.55). The DDI was 7.5 3.0 min for the immediate GA group , 8.3 2.2 min for the EA group, and 9.0 2.5 min for the EA attempted-subsequently converted to GA group (p = 0.48). The 5-minute Apgar score was 9 (2-9) in the GA group and 9 (8-9) in the EA group (p = 0.10). The neonatal cord blood pH was 7.23 0.10 for the immediate GA group, 7.23 0.06 for the EA group, and 7.23 0.05 for the EA attempted-subsequently converted to GA group (p = 0.97). The incidence of nausea/vomiting was 15.5 % in the GA group and 22.2 % in the EA group (p = 0.63), while that of hypotension was 8.5 % in the GA group and 22.2 % in the EA group (p = 0.22). One patient in the GA group had a difficult airway. Of the 98 cases, the three most common indications were fetal distress (68.4 %), cord prolapse (20.4 %) and abruptio placentae (6.1 %). The rest comprised two cases of uterine rupture and three cases of severe antepartum hemorrhage. There was no relationship between the DDI and the seniority of the anesthesiologist or obstetrician, or if activation was during or after office hours. 42.5 % of cases were during office hours.

Conclusion: Following protocol initiation, for all crash cesarean sections, response times and perinatal outcome are acceptable for both epidural anesthesia extension and general anesthesia.

SOAP 2009