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Kang T, Tao J, Wang X, Liu Y, Jin D. Epidural ropivacaine versus bupivacaine for cesarean sections: a system review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2313356. [PMID: 38342577 DOI: 10.1080/14767058.2024.2313356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION It is still no consensus on the use of ropivacaine or bupivacaine in epidural anesthesia for cesarean section (CS), because their anesthetic potency and relative complications remains controversial. This system review and meta-analysis aimed to compare the efficacy of epidural ropivacaine and bupivacaine for elective CSs and investigate relative complications for parturients and neonates. METHODS We searched PubMed, MEDLINE, Embase, Cochrane Library, Science-Direct, and Google Scholar to June 30, 2023 for randomized controlled trials (RCTs), which compared epidural ropivacaine with bupivacaine for elective CSs. The success rate of epidural anesthesia (EA) was primary outcome. The secondary outcomes included onset times of sensory block, maternal side effects, neonatal Apgar scores and umbilical artery pH. RESULTS We analyzed 8 RCTs with 532 parturients. 0.75% ropivacaine is associated with a shorter onset time of sensory block than 0.5% bupivacaine (SMD = -0.43, 95% CI: -0.70 to -0.17; p = .001). 0.5% ropivacaine resulted in a reduced nausea than 0.5% bupivacaine (RR = 0.49, 95% CI: 0.28 to 0.83; p = .008). In addition, there were no significant difference between ropivacaine and bupivacaine groups in terms of success rate of epidural anesthesia, maternal side effects (hypotension, bradycardia, shivering), and neonatal Apgar scores and umbilical artery pH. CONCLUSIONS The findings suggest that there were no significant difference between epidural ropivacaine and bupivacaine for elective CSs in terms of the success rate (85.9% vs. 83.5), maternal side effects (hypotension, bradycardia, shivering), and neonatal Apgar scores and umbilical artery pH. But compared with 0.5% bupivacaine, epidural 0.75% ropivacaine was mildly effective for reducing onset time of sensory block and 0.5% ropivacaine reduced the incidence of maternal nausea.
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Affiliation(s)
- Tao Kang
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Jiwei Tao
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Xuetao Wang
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Yu Liu
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Dan Jin
- Department of Neurosurgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
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Vercoutere A, Racapé J, Zina MJ, Alexander S, Benoit K, Boulvain M, Goemaes R, Leroy C, Van Leeuw V, Costa E, Derisbourg S, Goffard JC, Roelens K, Vandenberghe G, Daelemans C. Did we observe changes in obstetric interventions in SARS-CoV-2 infected pregnant women at the beginning of COVID-pandemic in Belgium? Results of a nationwide population-based study. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100328. [PMID: 39155890 PMCID: PMC11327946 DOI: 10.1016/j.eurox.2024.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
Background Pregnant women are more vulnerable to the severe effects of COVID-19 compared to their non-pregnant peers. Early in the pandemic, there was a rise in cesarean deliveries and preterm births among infected pregnant women. This study aims to evaluate whether there were any changes in obstetric interventions during the first two waves of the pandemic in Belgium. Methods Between March 2020 and February 2021, the Belgian Obstetric Surveillance System (B.OSS) conducted an extensive, nationwide population-based registry study, that included nearly all births to women with a confirmed SARS-CoV-2 infection within six weeks before hospitalization in Belgium. The perinatal outcomes of these women were analyzed and compared with pre-pandemic regional perinatal data. Results A total of 923 SARS-CoV-2 infected pregnant women were admitted to the hospital; 9.3 % were hospitalized for severe COVID-19, while the remaining were hospitalized for obstetric reasons. Infected women had a higher median BMI, a higher incidence of diabetes, and a greater proportion were overweight or obese compared to the reference group (p < 0.001). While the majority of women gave birth vaginally, symptomatic women and those with a severe infection had slightly higher rates of cesarean delivery, though not statistically significant after adjusting for confounders. Only severely ill women had an increased risk of preterm delivery (aOR 2.3; 95 %CI [1.2-2.5]; p = 0.02) and of induced labor (OR 1.8; 95 %CI [1.1-2.8]; p = 0.01). The use of general anesthesia for cesarean delivery was more common in the infected group (OR 2.6; 95 %CI [1.6-4.1]; p < 0.001). Conclusions Obstetric interventions, such as cesarean delivery and induction, remained at pre-pandemic levels. However, a SARS-CoV-2 infection appears to have increased medically induced preterm delivery and the use of general anesthesia for cesarean delivery.
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Affiliation(s)
- An Vercoutere
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Obstetrics and Gynecology, Belgium
| | - Judith Racapé
- Ecole de santé publique, Université libre de Bruxelles (ULB), Belgium
| | | | - Sophie Alexander
- Ecole de santé publique, Université libre de Bruxelles (ULB), Belgium
| | - Karolien Benoit
- Belgian Obstetric Surveillance System, Ghent University Hospital, Ghent, Belgium
| | - Michel Boulvain
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Obstetrics and Gynecology, Belgium
| | - Régine Goemaes
- Study Centre for Perinatal Epidemiology (SPE), Brussels, Belgium
| | - Charlotte Leroy
- Centre d’Epidémiologie Périnatale (CEpiP), Brussels, Belgium
| | | | - Elena Costa
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Obstetrics and Gynecology, Belgium
| | - Sara Derisbourg
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Obstetrics and Gynecology, Belgium
| | - Jean-Christophe Goffard
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), CUB Hôpital Erasme, Department of Internal Medicine, Belgium
| | - Kristien Roelens
- Belgian Obstetric Surveillance System, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Griet Vandenberghe
- Belgian Obstetric Surveillance System, Ghent University Hospital, Ghent, Belgium
- Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Caroline Daelemans
- Obstetric Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
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Xu Y, Shou Y, Li Y, Chen D, Wen Y, Huang X, Li Y. Virtual reality treatment could reduce anxiety for women undergoing cesarean section with spinal anesthesia: a randomized controlled trial. Arch Gynecol Obstet 2024; 310:1509-1516. [PMID: 38795137 DOI: 10.1007/s00404-024-07556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 05/14/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE Cesarean section may result in adverse psychosocial and behavioral outcomes because women put considerable emphasis on the process of birth. Virtual reality treatment has been shown by many studies to reduce anxiety and improve patient satisfaction. Therefore, we designed a randomized controlled trial to investigate whether the application of virtual reality technology during cesarean section can reduce maternal anxiety and improve satisfaction. METHODS We recruited 128 women undergoing elective cesarean delivery with proposed spinal anesthesia and randomly assigned them to either virtual reality or routine care. The virtual reality intervention was a virtual reality program tailored specifically for women undergoing cesarean section. Primary outcome was the change in anxiety score (change = preoperative-intraoperative score). Secondary outcomes included patient satisfaction score, requirement of intraoperative sedative and analgesic drugs, and respiratory rate. RESULTS The change in anxiety score in the virtual reality group was significantly higher than that in the routine care group (30 [20, 47.5] vs 10 [- 10, 23.8], respectively; P < 0.001, with Hodges-Lehmann median difference estimate of 20 (95% confidence interval CI, 15-30)). There were no significant differences between the two groups in patient satisfaction scores, the requirement of intraoperative sedative and analgesic drugs, and respiratory rate and side effects. CONCLUSION Virtual reality treatment could reduce the anxiety of women undergoing elective cesarean section, which is beneficial to the mother and baby. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2200061936) on July 11, 2022, and can be reached at https://www.chictr.org.cn/showprojEN.html?proj=173329.
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Affiliation(s)
- Yang Xu
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yunfeng Shou
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yilu Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Daili Chen
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yajie Wen
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xiaolei Huang
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yuantao Li
- Department of Anesthesiology, Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China.
- Biomedical Research Institute, Hubei University of Medicine, Shiyan, China.
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Sieker M, Weber T, Vogelsang H, Kern P. [Anesthesia for cesarean section with diastrophic dysplasia]. DIE ANAESTHESIOLOGIE 2024:10.1007/s00101-024-01440-2. [PMID: 39103635 DOI: 10.1007/s00101-024-01440-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 06/01/2024] [Accepted: 06/15/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Michaela Sieker
- Klinik für Anästhesiologie und Intensivmedizin, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44891, Bochum, Deutschland.
| | - Thomas Weber
- Klinik für Anästhesiologie und Intensivmedizin, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44891, Bochum, Deutschland
| | - Heike Vogelsang
- Klinik für Anästhesiologie und Intensivmedizin, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44891, Bochum, Deutschland
| | - Peter Kern
- Klinik für Gynäkologie und Geburtshilfe, St. Elisabeth-Hospital Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
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Kim MK, Kim I, Kang H, Wi W, Park YH, Jung YH, Woo YC, Baek CW. Effect of intravenous palonosetron on hypotension induced by spinal anesthesia for cesarean section: A randomized controlled trial. PLoS One 2024; 19:e0305913. [PMID: 38917195 PMCID: PMC11198823 DOI: 10.1371/journal.pone.0305913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the impact of intravenous palonosetron compared to ondansetron on hypotension induced by spinal anesthesia in women undergoing cesarean section. METHODS Fifty-four women scheduled for elective cesarean section were, randomly allocated to ondansetron group (n = 27) or palonosetron group (n = 27). Ten minutes prior to the administration of spinal anesthesia, participants received an intravenous injection of either ondansetron or palonosetron. A prophylactic phenylephrine infusion was initiated immediately following the intrathecal administration of bupivacaine and fentanyl. The infusion rate was titrated to maintain adequate blood pressure until the time of fetal delivery. The primary outcome was total dose of phenylephrine administered. The secondary outcomes were nausea or vomiting, the need for rescue antiemetics, hypotension, bradycardia, and shivering. Complete response rate, defined as the absence of postoperative nausea and vomiting and no need for additional antiemetics, were assessed for up to 24 hours post-surgery. RESULTS No significant differences were observed in the total dose of phenylephrine used between the ondansetron and palonosetron groups (387.5 μg [interquartile range, 291.3-507.8 μg versus 428.0 μg [interquartile range, 305.0-507.0 μg], P = 0.42). Complete response rates also showed no significant differences between the groups both within two hours post-spinal anesthesia (88.9% in the ondansetron group versus 100% in the palonosetron group; P = 0.24) and at 24 hours post-surgery (81.5% in the ondansetron group versus 88.8% in the palonosetron group; P = 0.7). In addition, there was no difference in other secondary outcomes. CONCLUSION Prophylactic administration of palonosetron did not demonstrate a superior effect over ondansetron in mitigating hemodynamic changes or reducing phenylephrine requirements in patients undergoing spinal anesthesia with bupivacaine and fentanyl for cesarean section.
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Affiliation(s)
- Min Kyoung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Injeong Kim
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Wongook Wi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Yong Hee Park
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Yong Hun Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, South Korea
| | - Young Cheol Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Chong Wha Baek
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea
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Liu C, Chu R, Song N, Yang Q, Song X, Li L, Zhang M, Li Y, Xu Y, Li Y, Ma Y. Perinatal outcomes comparison between neuraxial and general anesthesia in pregnant women with placenta accreta spectrum: a multicenter retrospective study. J Anesth 2024; 38:167-178. [PMID: 38345633 DOI: 10.1007/s00540-023-03287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/10/2023] [Indexed: 03/21/2024]
Abstract
PURPOSE We investigated the impact of anesthesia mode on perinatal outcomes in patients with placenta accreta spectrum (PAS) undergoing cesarean delivery and identified factors associated with adverse perinatal events. METHODS The multicenter retrospective analysis was conducted in patients with PAS who delivered at three medical centers. Patients were classified according to whether they received general anesthesia (GA) or neuraxial anesthesia (NA). We compared the basic clinical characteristics of patients in the pre-propensity score matching (PSM) and post-PSM cohorts and identified factors associated with a high risk of adverse maternal outcomes. RESULTS This study included a total of 425 patients, with 307 (72.2%) in the GA group and 118 (27.8%) in the NA group. After PSM, 162 patients were identified for analysis. In the post-matched cohort, the NA group exhibited shorter total operation time (P = 0.030) and postoperative length of hospital stay (P = 0.037). Additionally, the NA group experienced lower intraoperative blood loss (P < 0.001) and received fewer units of transfused packed red blood cells (PRBC) (P < 0.001). Multivariate logistic regression analysis indicated that GA (P < 0.001), emergency cesarean delivery (P = 0.010), vascular lacunae within the placenta (P < 0.001), hypervascularity of uterine-placental margin (P = 0.002), hypervascularity of the cervix (P = 0.014), and balloon placement in the abdominal aorta (P < 0.001) were associated with a high risk of adverse maternal events. CONCLUSION In comparison to GA, cesarean delivery with NA in PAS patients appears to be associated with reduced intraoperative blood loss, PRBC transfusion, operating duration, and postoperative hospital stay.
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Affiliation(s)
- Chenmian Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
| | - Ran Chu
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingsi Road, Jinan, Shandong, People's Republic of China
| | - Ningning Song
- Department of Obstetrics and Gynecology, People's Hospital of Rizhao, Rizhao, Shandong, People's Republic of China
| | - Qiuhong Yang
- Department of Obstetrics and Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong, People's Republic of China
| | - Xiao Song
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, Shandong, People's Republic of China
| | - Liang Li
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China
| | - Meiling Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
- Department of Obstetrics and Gynecology, Qingdao Women and Children's Hospital, Qingdao, Shandong, People's Republic of China
| | - Yarong Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
- Department of Obstetrics and Gynecology, Jinan Maternity and Child Care Hospital, Jinan, Shandong, People's Republic of China
| | - Yintao Xu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China
| | - Yanan Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China.
| | - Yuyan Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, Shandong, People's Republic of China.
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Gabbai D, Lavie A, Yogev Y, Attali E. The association between indications for cesarean delivery and surgery time. Int J Gynaecol Obstet 2024; 164:693-698. [PMID: 37545296 DOI: 10.1002/ijgo.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE We aimed to determine risk factors for prolonged surgery time of cesarean delivery (CD). METHODS We conducted a retrospective cohort study in a single tertiary university-affiliated medical center (2011-2022). The study group consisted of all women who underwent CD that lasted >90 min (representing the 95th percentile of CD length in our cohort). Data were compared with CDs with an operation time of <90 min. Demographic, obstetric, and surgical characteristics, as well as indications for surgery and urgency (in labor vs. elective surgery), were compared. RESULTS Overall, during the study period, 31 660 CDs were performed in our center. Of them, 1397 (4.4%) lasted >90 min. After applying a multivariate analysis, abnormal placentation (relative risk [RR] 1.5 [95% confidence interval (CI), 1.3-1.8]), previous uterine scar (RR, 2.15 [95% CI, 1.5-3.0]), general anesthesia (RR, 3.5 [95% CI, 2.9-4.4]) and preterm delivery (RR, 2.06 [95% CI, 1.78-2.4]) were found to be associated with prolonged surgical time. CD due to malpresentation (RR, 0.57 [95% CI, 0.46-0.7]), multiple gestations (RR, 0.72 [95% CI, 0.6-0.9]), and patient request (RR, 0.56 [95% CI, 0.38-0.84]) were found to be protective factors. CONCLUSION The main risk factors associated with additional surgery time in CD are general anesthesia, abnormal placentation, previous uterine scar, and preterm delivery.
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Affiliation(s)
- Daniel Gabbai
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Lavie
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmanuel Attali
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shi X, Xu C, Wen Y, Jiang M, Yu H, Wang X, Yuan H, Feng S. Perinatal outcome of emergency cesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis. BMC Anesthesiol 2024; 24:33. [PMID: 38243205 PMCID: PMC10797910 DOI: 10.1186/s12871-024-02412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE An emergency cesarean section (CS), which is extremely life-threatening to the mother or fetus, seems to be performed within an adequate time horizon to avoid negative fetal-maternal denouement. An effective and vigilant technique for anesthesia remains vital for emergency cesarean delivery. Therefore, this study aimed to validate the impact of various anesthesia tactics on maternal and neonatal outcomes. METHOD This was a retrospective cohort study of parturient patients who were selected for emergency CS with the assistance of general or neuraxial anesthesia between January 2015 and July 2021 at our institution. The 5-min Apgar score was documented as the primary outcome. Secondary outcomes, including the 1 min Apgar score, decision-to-delivery interval (DDI), onset of anesthesia to incision interval (OAII), decision to incision interval (DII), duration of operation, length of hospitalization, height and weight of the newborn, use of vasopressors, blood loss, neonatal resuscitation rate, admission to neonatal intensive care unit (NICU), duration of NICU and complications, were also measured. RESULTS Of the 539 patients included in the analysis, 337 CSs were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSEA). The Apgar scores at 1 min and 5 min in newborns receiving GA were lower than those receiving intraspinal anesthesia, and no difference was found between those receiving EA and those receiving CSEA. The DDI of parturients under GA, EA, and CSE were 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. The DDI and DII of GA and EA were shorter than those of CSE, and the DDI and DII were similar between GA and EA. Compared to that in the GA group, the OAII in the intraspinal anesthesia group was significantly greater. GA administration correlated with more frequent resuscitative interventions, increased admission rates to NICU, and a greater incidence of neonatal respiratory distress syndrome (NRDS). Nevertheless, the duration of NICU stay and the incidence rates of neonatal hypoxic ischemic encephalopathy (HIE) and pneumonia did not significantly differ based on the type of anesthesia performed. CONCLUSION Compared with general anesthesia, epidural anesthesia may not be associated with a negative impact on neonatal or maternal outcomes and could be utilized as an alternative to general anesthesia in our selected patient population following emergency cesarean section; In addition, a comparably short DDI was achieved for emergency cesarean delivery under epidural anesthesia when compared to general anesthesia in our study. However, the possibility that selection bias related to the retrospective study design may have influenced the results cannot be excluded.
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Affiliation(s)
- Xueduo Shi
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Chenyang Xu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Yazhou Wen
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Ming Jiang
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Huiling Yu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Xian Wang
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China
| | - Hongmei Yuan
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China.
| | - Shanwu Feng
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu Province, China.
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Zanfini BA, Di Muro M, Biancone M, Catarci S, Piersanti A, Frassanito L, Ciancia M, Toni F, Santantonio MT, Draisci G. Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study. J Clin Med 2023; 12:7720. [PMID: 38137789 PMCID: PMC10744071 DOI: 10.3390/jcm12247720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
ESP block (ESPB) and posterior Quadratus Lumborum Block (pQLB) have been proposed as opioid-sparing techniques for the management of pain after abdominal surgery. Between December 2021 and October 2022, we conducted a retrospective comparative study at the delivery suite of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, to compare the efficacy of ESPB and pQLB in preventing postoperative pain after an elective caesarean section (CS). The primary outcome was total morphine consumption in the first 24 h. Secondary outcomes were time to first opioid request; Numerical Pain Rating Scale (NPRS) at 0, 2, 6, 12 and 24 h; vital signs; adverse events. Fifty-two women were included. The total cumulative dose of morphine was not significantly different between the two groups of patients (p = 0.897). Time to first dose of morphine, NPRS values and haemodynamic parameters were not statistically different between the two groups. NPRS values significantly increased (p < 0.001) at the different time intervals considered. The need for rescue doses of morphine was lower in the ESPB group compared to the pQLB group (hazard ratio of 0.51, 95% CI (0.27 to 0.95), p = 0.030). No adverse event was reported. ESPB seems to be as effective as pQLB in providing analgesia after CS.
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Affiliation(s)
- Bruno A. Zanfini
- Department of Anaesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
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Vasile F, La Via L, Murabito P, Tigano S, Merola F, Nicosia T, De Masi G, Bruni A, Garofalo E, Sanfilippo F. Non-Invasive Monitoring during Caesarean Delivery: Prevalence of Hypotension and Impact on the Newborn. J Clin Med 2023; 12:7295. [PMID: 38068347 PMCID: PMC10707670 DOI: 10.3390/jcm12237295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/30/2023] [Accepted: 11/23/2023] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The aim of our study was to investigate the prevalence of perioperative hypotension after spinal anesthesia for cesarean section using non-invasive continuous hemodynamic monitoring and its correlation with neonatal well-being. METHODS We included 145 patients. Spinal anesthesia was performed with a combination of hyperbaric bupivacaine 0.5% (according to a weight/height scheme) and fentanyl 20 μg. Hypotension was defined as a mean arterial pressure (MAP) < 65 mmHg or <60 mmHg. We also evaluated the impact of hypotension on neonatal well-being. RESULTS Perioperative maternal hypotension occurred in 54.5% of cases considering a MAP < 65 mmHg and in 42.1% with the more conservative cut-off (<60 mmHg). Severe neonatal acidosis occurred in 1.4% of neonates, while an Apgar score ≥ 9 was observed in 95.9% at 1 min and 100% at 5 min. CONCLUSIONS Continuous non-invasive hemodynamic monitoring allowed an early detection of maternal hypotension leading to a prompt treatment with satisfactory results considering neonatal well-being.
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Affiliation(s)
- Francesco Vasile
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
| | - Luigi La Via
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
| | - Paolo Murabito
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
| | - Stefano Tigano
- School of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.T.); (F.M.)
| | - Federica Merola
- School of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.T.); (F.M.)
| | - Tiziana Nicosia
- School of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (S.T.); (F.M.)
| | - Giuseppe De Masi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera “Santa Maria”, 05100 Terni, Italy;
| | - Andrea Bruni
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (A.B.); (E.G.)
| | - Eugenio Garofalo
- School of Anesthesia and Intensive Care, University “Magna Graecia”, 88100 Catanzaro, Italy; (A.B.); (E.G.)
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G. Rodolico-San Marco”, 95123 Catania, Italy; (F.V.); (P.M.); (F.S.)
- Department of General Surgery and Medical—Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania, 95123 Catania, Italy
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Do W, Cho AR. What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives. Anesth Pain Med (Seoul) 2023; 18:114-122. [PMID: 37183279 PMCID: PMC10183619 DOI: 10.17085/apm.23041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Sugammadex is a chemically modified γ-cyclodextrin that is used as a selective reversal agent for steroidal neuromuscular blockade. The use of sugammadex has greatly increased globally; however, little is known about its potential adverse effects in pregnant and lactating women or those using hormonal contraceptives. There are three important theoretical assumptions. Firstly, pregnancy-related physiological changes involve most organs and affect the pharmacokinetic profiles of medications. Considering the physiological changes in pregnant women and the pharmacokinetic properties of sugammadex, alterations in the dosage and safety profiles of sugammadex may occur during pregnancy. Secondly, very large and polarized sugammadex molecules are expected to have limited placental transfer to the fetus and excretion into breast milk. Finally, sugammadex can bind to steroidal neuromuscular blocking agents as well as other substances with similar structures, such as progesterone. As a result of using sugammadex, progesterone levels can be reduced, causing adverse effects such as early pregnancy cessation and failure of hormonal contraceptives. This narrative review aims to demonstrate the correlations between sugammadex and pregnancy, lactation, and reproductive potential based on previously published preclinical and clinical studies. This will bridge the gap between theoretical assumptions and currently unknown clinical facts. Moreover, this review highlights what anesthesia providers should be aware of and what actions to take while administering sugammadex to such patients.
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Affiliation(s)
- Wangseok Do
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ah-Reum Cho
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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