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

Anesthesia for Cervical Cerclage

Abstract Number: 181
Abstract Type: Original Research

Robin Russell MD FRCA1 ; Desi Choi MB FRCA2

Introduction: Cervical cerclage to prevent preterm delivery may be performed as either an elective (before cervical dilatation) or emergency (when cervical change has been diagnosed) procedure. There are few data on anesthetic techniques for cervical cerclage.1,2 Regional anesthesia (RA) avoids the hazards of general anesthesia (GA), but if the cervix is dilated and membranes bulging, GA has been recommended to provide uterine relaxation.3

Method: The notes of all women undergoing elective and emergency cervical cerclage between 2004-08 were reviewed. Data on anesthetic technique were collected.

Results: Cervical cerclage was performed on 137 women. Anesthetic charts were available in 97 (71%). RA was used in 87, GA in 10. Of the GA cases nine refused RA, and one had Von Willebrands disease. Spinal anesthesia was the most common technique, using a median dose of 11.25mg 0.5% hyperbaric bupivacaine (range 7.5-14mg) in elective cases, and 11.mg (9-12.5mg) for emergencies. In the 36 elective and 12 emergency cases in which intrathecal fentanyl was used, the mean dose was 12.5mcg (range 10-20mcg) for elective surgery and 12.5mcg (10-15mcg) for emergencies. Sensory block height was T10 or higher in 45 elective cases, and 13 emergency cases. Sensory block height was below T10 in four elective and two emergency cases. Block height was not documented in 21 cases. Of the elective cases, two women received iv sedation, and one woman required intraoperative iv fentanyl for inadequate analgesia; despite a bilateral T8-S5 sensory block to touch. No supplementation was needed in the emergency group. One woman required an epidural blood patch for a post-dural puncture headache.

Discussion: Our results suggest that RA is possible for both elective and emergency cervical cerclage. Further studies are required to establish the optimum solution for spinal anesthesia and the block height necessary for pain free surgery.

References

1. Engles ED. A retrospective study of regional vs general anesthesia for cervical cerclage and review of the literature. Anesthesiology 1989; 71: A888.

2. Yoon HJ, Hong JY, Kim SY. The effect of anesthetic method for prophylactic cervical cerclage on plasma oxytocin: a randomized trial. Int J Obstet Anesth 2008; 17: 26-30.

3. Chantigan RC, Chantigan PDM. Problems of early pregnancy. In: Chestnut DH, ed. Obstetric Anesthesia Principles and Practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004: 247-9.



SOAP 2009