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SPINAL ANESTHETIC TO INCISION DURING CESAREAN SECTION: HOW LONG IS TOO LONG?
Abstract Number: F-41
Abstract Type: Original Research
Improving operating room safety and efficiency has received much attention over the past decade. This however has been relatively minimally translated into labor and delivery operating suites. In our academic practice, we have noted that prolonged delays in surgical start times may significantly contribute to sooner anesthetic ware and subsequent maternal exposure to supplemental anesthetics/analgesics. Within the context of improving both safety and efficiency, we sought to evaluate the average time interval between intrathecal anesthetic placement and surgical start.
Evaluate the average time between placement of intrathecal anesthetic to surgical incision during routine cesarean section. Secondary objectives included: (1) the frequency of supplemental anesthetic adjuncts utilized, in reference to both anesthetic technique as well as intra-operative times, and (2) the evaluation of neonatal outcomes based upon Apgar scoring at 1 and 5 minutes.
Retrospective pilot study of parturients undergoing non-emergent cesarean section. Data was collected from 113 subjects at a single academic institution whom had received intrathecal bupivacaine (10.5-12mg), morphine (150mcg) and fentanyl (15mcg) via either a single shot spinal (SSS) or a combined spinal/epidural (CSE). Anesthetic to incision time, total surgical time, total anesthetic time (anesthetic to incision time + total surgical time), delivery of supplemental anesthetic (e.g opiates, ketamine, nitrous, epidural agents), in addition to neonatal Apgar scores at 1 and 5 minutes were assessed.
The average time between intrathecal anesthetic placement and surgical incision was 19.2 +/- 5.5 minutes. Those receiving a SSS had a relative risk (RR) of 1.73 (p<0.05) of receiving an adjunct anesthetic when the anesthetic to incision delay was greater than 19 minutes. No similar associations were identified within those whom had received a CSE (RR = 0.98). A significant correlation was also demonstrated between supplemental anesthetic administration to both total surgical time (p<0.001) and total anesthetic time (P<0.05). No relationship was identified between anesthetic to incision time and neonatal Apgar scores.
The average spinal anesthetic placement to incision time was 19.2 minutes. A prolonged anesthetic to incision delay will significantly contribute to the frequency of supplemental anesthetics used, particularly to those receiving a single shot spinal.