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General Anesthesia Rate and Use of Anesthetic Adjuncts for 3,143 Cesarean Deliveries
Abstract Number: T2A-346
Abstract Type: Original Research
Introduction: One institution reported a cesarean delivery (CD) under general anesthesia (GA) rate of less than one percent but did not report the use of anesthetic adjuncts that ostensibly facilitated this low rate1. In 2013, our department liberalized our approach to GA for CD in response to a series of morbidity and mortality conferences where presented patients underwent CD with apparent inadequate analgesia. Our primary aim was to report our GA for CD rate and our secondary aim was to report our use of anesthetic adjuncts for CD for a period of four academic years.
Methods: Using our institution’s official handwritten labor and delivery unit log of deliveries, we verified capture of every CD from July 1, 2014 to June 30, 2018. For CD that did not undergo GA, data including anesthetic technique and use of anesthetic adjuncts including intravenous (IV) fentanyl, IV ketamine, and inhaled nitrous oxide was collected. A more detailed data collection was performed for subjects who underwent GA, which included demographic information, indication for GA, how the airway was secured, and serious complications.
Results: 3,143 CD were performed during the study period. 2640, 235, and 11 subjects appeared once, twice, and three times in the study, respectively. Our GA for CD rate for the entire study period was 11.99%. 147(4.68%), 315(10.02%), and 68(2.16%) of total CD received inhaled nitrous oxide, IV fentanyl, and IV ketamine, respectively, without GA. 65(2.07%) of CD received both inhaled nitrous oxide and IV fentanyl without GA. 16(0.51%) of CD received inhaled nitrous oxide, IV fentanyl, and IV ketamine without GA. 2293(72.96%) of CD received no anesthetic adjuncts. 377 subjects received GA for CD; 124(3.95%), 171(5.44%), and 82(2.61%) were for perceived inadequate time to initiate neuraxial anesthesia, failure of neuraxial anesthetic, and maternal comorbidities/preference, respectively. Serious complications included one aspiration during an emergent CD and one high spinal block. There were no failed airways or maternal deaths.
Discussion: Our GA for CD rate of 11.99% was higher than the 5.6% reported in the SCORE study2; our neuraxial failure rate of 5.44% was higher than the 1.7% reported in the same study. Our deviation in outcomes from the SCORE study could reflect a more aggressive approach to inadequate analgesia. Our study was not powered to detect serious complications. Further large studies examining the relationship between patient satisfaction and anesthetic technique for CD are needed.
1. Palanisamy A, et al. General anesthesia for cesarean delivery at a tertiary care hospital from 2000-2005: a retrospective analysis and 10-year update. Int J Obstet Anesth 2011;20:10-6
2. D’Angelo R, et al. Serious complications related to obstetric anesthesia: the serious complication repository project of the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2014;120:1505-12