///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

A Survey of Obstetric Anesthetic Practice for Cesarean Section

Abstract Number: 166
Abstract Type: Original Research

Leinani S Aono-Le Tagaloa FANZCA1 ; Alexander Butwick FRCA2; Brendan Carvalho FRCA3

Background: There is limited information detailing neuraxial anesthetic practices for patients undergoing Cesarean section(CS). The aim of this survey was to review anesthetic practices (perioperative and postoperative) for patients undergoing elective and urgent CS among members of the Society of Obstetric Anesthesia and Perinatology(SOAP).

Methods: We developed an online survey (http://freeonlinesurveys.com) consisting of 37 questions covering various aspects of anesthesia and postoperative analgesia for elective and urgent CS. Following IRB approval, emails were individually forwarded to SOAP members with information directing respondents to the online survey. The survey was tested for internal validity and consistency among obstetric anesthesiologists within the investigators institution. The mode of anesthesia, type and dose of preferred neuraxial local anesthetic and opioid, and the postoperative analgesics and monitoring utilized by respondents in the survey were assessed. Data are presented as median [range] and percentages as appropriate.

Results: 384 responses were received (response rate of 36%). 85% of respondents use spinal anesthesia for elective CS. Most respondents (90%) use hyperbaric bupivacaine 0.75% intrathecally (median dose = 12 mg [6-15 mg]). Intrathecal fentanyl and morphine are also used by 79% and 77% respondents respectively. The median intrathecal dose of morphine was 200 mcg [50-400 mcg]. Epidural lidocaine 2% (median top-up=20 ml [10-25 ml]) is the preferred agent (74% respondents) for patients requiring urgent CS with a pre-existing labor epidural. The majority of respondents (93%) report having an institutional protocol to monitor for postoperative respiratory depression after administration of neuraxial opioids (91% use respiratory rate, 61% use sedation scores, 30% use pulse oximetry). Postoperative analgesic regimens following CS include: NSAIDS, acetaminophen, oxycodone and hydrocodone in 81%, 45%, 25% and 27% respondents in our survey respectively. Postoperative epidural analgesia is used by 21% of respondents. The obstetrical teams are responsible for managing post-CS analgesia in 21% of institutions within our survey.

Conclusion: The majority of respondents in our survey use spinal anesthesia with intrathecal bupivacaine, fentanyl and morphine for uncomplicated elective CS. Lidocaine is the preferred epidural top-up for urgent CS for patients with a pre-existing labor epidural. However, there is marked variability in practices for monitoring respiratory depression post-CS and for providing postoperative analgesia among respondents in the survey. Further studies are needed to explore the basis for these specific variations in anesthetic practice.

References: 1. Anesthesiology 2005;103:645-53 2. Anesth Analg 2008;107:956-61

SOAP 2009