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Failed Neuraxial Anesthesia for Cesarean Section: What is the Next Step?
Abstract Number: S-34
Abstract Type: Original Research
Background: Patients presenting for C/S with failed neuraxial anesthesia (FNA) represent a challenge for anesthesiologists. Subsequent decision-making varies across the spectrums of practice style, clinical presentation & provider experience. Our study aimed to identify trends in decision-making and the associated outcomes & complications upon presentation of FNA in patients undergoing C/S.
Methods: After IRB approval for exemption, a retrospective analysis of OB anesthesia outcomes will be completed on review of anesthetic records & data collected prospectively between 2004 and 2008 as part of an ongoing Quality Assurance (QA) program on patients with FNA for C/S. Pertinent data, such as demographics, timing/sequence of events & time required for anesthetic attempts, and maternal/fetal outcomes including failures and complications, were retrieved and analyzed. Descriptive data were reported as numbers & mean ±SD; incidence and proportion in %. Unpaired t-test, Fisher exact test and Chi-squares were used to compare between groups as appropriate.
Results: So far 18 months' data with 106 FNAs have been retrieved and analyzed. Overall incidence of failed labor epidural catheter when presenting for C/S was 9.35%, and 2.41% with failed SAB. Management of these FNAs and the related complications/outcomes are shown in attached Table 1. The final complete data analysis will be presented at the SOAP annual meeting.
Discussion: Preliminary data suggests that GA as initial anesthetic choice after FNA is the fastest and we did not have any occurrences of difficult intubation. This is likely not due to improved airway techniques since almost all airway control was achieved via direct laryngoscopy. Rather, it may be due to judicious selection of patients with favorable airway indices for GA. SAB after FNA is achieved faster with higher success than epidural anesthetic. However, high block requiring intubation seems to occur more frequently with SAB as the subsequent anesthetic after either failed initial epidural or failed SAB. Replacing failed labor epidural catheter for C/S with a 2nd epidural catheter may take over 30 minutes from anesthetic initiation to skin incision, and with higher failure rate that may occur during surgery in progress. Finally, age, weight, height, BMI and need for interpreters do not appear to be independent predictors of the subsequent anesthetic choice after FNA.