///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

How fast are we? General versus spinal anesthesia for emergency cesarean section

Abstract Number: 34
Abstract Type: Original Research

Joanne Douglas MD FRCPC1 ; Arry Kathirgamanathan MBBChir FRCA2; Jessie Tyler BSc3; Simrat Saran MD4; Roanne Preston MD FRCPC5; Paul Kliffer MD FRCPC6

Introduction: The Royal College of Obstetricians and Gynaecologists (UK) recommend a 30 minute decision-to-delivery time when there is risk to mother or fetus (1). Thus, time to achieve surgical anesthesia should be kept as short as possible. In the absence of a pre-existing labor epidural, general (GA) or spinal anesthesia (SA) can be administered. A prospective randomized controlled trial comparing the two techniques under emergency conditions is unethical. Simulation of emergency scenarios allows anesthetists to practice safe anesthesia. Hence we undertook a simulation based observational study.

Methods: After ethical approval, nineteen consultants and fellows in obstetric anesthesia were evaluated with regards to the speed of induction of GA versus SA. Assumptions that were made were: parturient was healthy with a normal airway and back, anesthetic machine and equipment were checked, standard monitoring was attached, and emergency drugs were drawn up.

GA was simulated on an airway training manikin (Laerdal, Norway). GA simulation time included: preoxygenation, injection of drugs into an intravenous line, application of cricoid pressure and intubation of the trachea.

SA was performed on a Styrofoam model of the back with a saline bag attached to simulate cerebrospinal fluid. SA time included opening of the SA tray, application of gloves, sterile preparation, drawing up of drugs, local anesthetic infiltration, spinal needle insertion and injection.

Time for GA was from entry of anesthesiologist into the operating room (OR) and finished when they said surgery could start. Time for SA was from entry of anesthesiologist into the OR to end of injection of spinal drugs (simulated). Time to obtain surgical anesthesia cannot be simulated, so it was measured clinically in 100 elective cesarean sections (CS) having SA in the lateral position. End of intrathecal injection to "ready for surgery" time was measured.

Results:

Values are median (range)

Conclusion: Induction of GA for emergency CS is more rapid than SA. The limiting factor in SA is the unpredictable variation in the time taken for the onset of surgical block.

References

(1) Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. The Use of Electronic Fetal Monitoring: The Use and Interpretation of Cardiotocography in Intrapartm Fetal Monitoring. Evidence -based Clinical Guideline No 8, London: RCOG Press; 2001.



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