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Risk Factors for the use of General Anesthesia for Cesarean Sections: A systematic review
Abstract Number: SA-28
Abstract Type: Original Research
General anesthesia use for Cesarean section (GACS) is not ideal due to the lack of maternal participation in the delivery and risk of airway compromise.1 Although reviews have examined risk factors for neuraxial anesthesia failure, no reviews have addressed primary use of GACS. The objective of this study is to identify the risk factors associated with primary use of GACS.1
A literature search was performed using PubMed, The Cochrane Library, and Scopus for epidemiologic studies and clinical trials between January 1971 and December 2015 referencing risk factors for pregnant patients receiving GACS. The search terms included synonyms for “general anesthesia”, “neuraxial anesthesia”, and “Cesarean section”. Included studies had patients undergoing cesarean sections with a primary (“intended”) or secondary (“back up”) general anesthetic. Studies were excluded if they were abstracts, not in English, or failed to report any association with GACS or risk factors for GACS.
The search yielded 2,565 combined results of which 12 studies underwent review. Worldwide, the most common risk factors for primary GACS include: BMI > 31.52, low-volume regional (non-urban) hospitals3, perceived lack of time4, Category II and III fetal heart tracing4-6, early gestational age7, abnormal placentation5, 6, 8, antepartum hemorrhage4, coagulopathy4, 6, preeclampsia4, malpresentation4, nighttime delivery5, failed neuraxial techniques9, non-obstetric anesthesiologist3, 10, and maternal congenital heart disease.7
Four studies showed a correlative association between primary GACS and: 1) emergency CS (i.e. Category II and III FHT, abnormal placentation, cord prolapse, uterine rupture, antepartum hemorrhage)4-6, 10, and 2) partial or inadequate neuraxial anesthesia9, 11-13. Two studies showed increased likelihood of receiving GACS related to: 1) having anesthesia provided by a non-obstetric trained anesthesiologist3, 10, and 2) anesthesiologists perceiving a lack of time to perform neuraxial anesthesia5, 11. One study showed that regionally located (non-urban) hospitals in the Czech Republic were more likely to perform GACS14.
Current research has identified patient-level risk factors for primary GACS and many fewer hospital- or provider-level risk factors for primary GACS. In order to develop interventions to decrease primary GACS, further research is needed to better characterize physician- and system-level predictors of GACS.