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Dedicated OB anesthesia coverage of labor and delivery decreases complications
Abstract Number: F3A-4
Abstract Type: Original Research
It has been reported that labor epidurals that are placed and managed by obstetric (OB) anesthesiologists are less likely to fail at time of cesarean delivery (CD). We sought to determine whether other complications of labor epidural management (accidental dural puncture (ADP), post-dural puncture headache (PDPH), replacement, top-ups) may also be decreased when an OB anesthesiologist is dedicated to supervise labor and delivery (L&D). This study was facilitated by a change in attending anesthesiologist coverage of L&D on weekends at our institution. Two study periods were defined: pre-coverage, where the attending anesthesiologist covering L&D was also supervising residents/CRNAs in the main operating room and was not generally a specialist in OB anesthesia; post-coverage, where the attending anesthesiologist on L&D was not supervising cases in the main operating room and was a specialist in OB anesthesia. A total of 1336 cases were reviewed over a 2 year period (665 pre-coverage, 671 post-coverage).
We did not find a difference in the rate of replacement of labor blocks (pre 5.7%, post 6.9%). However, the average time from placement until replacement was significantly longer in the pre-coverage period (595min) vs post-coverage period (361min)(p=0.038). The incidences of ADP and PDPH were not changed (ADP pre 1.4%, post 1.0%; PDPH pre 1.0%, post 0.8%).
Catheter failure resulting in general anesthesia (GA) for CD was reduced in the post-coverage period (pre 4.8%, post 0%, p=0.023). All instances of GA in the post-coverage period where an epidural catheter was already in place were for emergent indications (terminal bradycardia or cord prolapse). We found that laboring patients who required CD had more top-ups than those who delivered vaginally (p=0.008). For parturients requiring CD where an epidural catheter was not in place, the rate of GA was significantly reduced in the post-coverage period (pre 12.5%, post 2.5%, p=0.019). This suggests there was more rapid availability of the anesthesiologist with greater willingness to attempt and greater ability to successfully perform regional anesthesia for CD with urgent/emergent indications.
Consistent with previous studies we found significantly more top-ups for blocks that were replaced (p=0.028). The time from placement of the block until delivery was also significantly longer for blocks requiring replacement (p<0.01).
Campbell, Tran. Can J Anaes. 2009;56(1):19-26.
Riley, Papasin. IJOA. 2002;11(2):81-84.