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Anesthetic and obstetric predictors of general anesthesia in urgent or emergent cesarean delivery: a retrospective case-control study
Abstract Number: T2A-197
Abstract Type: Original Research
Introduction: Regional anesthesia (RA) is preferable to general anesthesia (GA) for cesarean delivery (CD). Use of GA in the pregnant woman is associated with increased maternal and neonatal morbidity.1 While RA is the preferred anesthetic technique for CD, GA may be necessary in certain situations. We sought to systematically evaluate current practices on our labour and delivery unit to identify anesthetic and obstetric predictors that may be modified to reduce our rates of GA for CD.
Methods: This was a retrospective, case-control study. Women undergoing urgent/emergent CD from January 1, 2015 to December 31, 2017 were identified. Of all women who received GA for urgent/emergent CD, 97 were selected at random, stratified by year; a corresponding control group was randomly selected of women who received RA for urgent/emergent CD, also stratified by year. Data included patient characteristics, pre-existing comorbidities, primary obstetric indication for CD, timing of events around delivery, post-partum complications, and neonatal outcomes. Specific anesthetic data included type of anesthetic administered, indication for specific anesthetic, and pertinent characteristics of airway management (GA group) and epidural analgesia in situ (RA group). Anesthetic and obstetric predictors of GA were examined using both univariate and multivariable analyses.
Results: 7282 CD were performed during the study period, of which 3681 were urgent/emergent (50.5%). Of all urgent/emergent CD, 254 were done under GA (6.9%). Non-reassuring fetal heart rate (NRFHR) was the most common obstetric indication for urgent/emergent CD amongst the cases (40%) and controls (40%). Amongst the cases, GA administration was most commonly due to “limited time due to maternal/fetal compromise” (56%), followed by “maternal contraindication to RA” (25%) and “inadequate RA” (17%) (Table 1). Possible anesthetic and obstetric predictors for GA for CD included primigravida (p=0.004), lower gestational age (p<0.001), ASA >2 (p<0.001), NRFHR (p=0.03), cord/fetal prolapse (p=0.0009), and Code 77 (“maternal/fetal emergency”) activation (p=0.0016).
Conclusion: Identification and timely interdisciplinary communication of risk factors leading to NRFHR and cord/fetal prolapse may allow for advance anesthetic planning and avoidance of GA for urgent/emergent CD. Opportunities to improve technical aspects and surveillance of regional anesthesia should also be sought.
References: 1IJOA 2011;20;10-16