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Wang L, Liu C, Wang X, Zhu S, Zhang L, Wang B, Yu Y. The impact of general anesthesia on the outcomes of preterm infants with gestational age less than 32 weeks delivered via cesarean section. Front Pharmacol 2024; 15:1360691. [PMID: 38572432 PMCID: PMC10987865 DOI: 10.3389/fphar.2024.1360691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Background Recent advancements in China's perinatal and neonatal intensive care have significantly reduced neonatal mortality, yet preterm births before 32 weeks remain the primary cause of neonatal fatalities and contribute to long-term disabilities. The prognosis of very preterm infants (VPIs) is significantly affected by factors including the intrauterine environment, delivery method and neonatal intensive care. Cesarean section which often used for preterm births has implications that are not fully understood, particularly concerning the type of anesthesia used. This study examines the impact of general anesthesia (GA) during cesarean delivery on VPI outcomes, aiming to identify strategies for mitigating GA-associated risks. Methods This cohort study analyzed 1,029 VPIs born via cesarean section under 32 weeks' gestation at our single-center from 1 January 2018, to 31 December 2022. Detailed medical records, encompassing perioperative information, maternal data and neonatal outcomes were meticulously examined. The primary aim of this investigation was to compare maternal characteristics and neonatal outcomes between VPIs delivered under GA and neuraxial anesthesia (NA). A significance level of p < 0.05 was established. Results Of the 1,029 VPIs analyzed, 87.95% (n = 905) were delivered via NA and 12.05% (n = 124) via GA. Mothers with hypertensive pregnancy diseases and emergency operations were more inclined to choose GA. VPIs delivered under GA showed a lower Apgar score at one and 5 minutes (p < 0.01), increased need for tracheal intubation resuscitation (32.2% vs. 12.2%, p < 0.01) and a greater incidence of severe neurological injury (SNI) (14.5% vs. 5%, p < 0.01). Multivariable analysis revealed GA was significantly associated with lower Apgar scores at one (OR 6.321, 95% CI 3.729-10.714; p < 0.01) and 5 minutes (OR 4.535, 95% CI 2.975-6.913; p < 0.01), higher risk of tracheal intubation resuscitation (OR = 3.133, 95% CI = 1.939-5.061; p < 0.01) and SNI (OR = 3.019, 95% CI = 1.615-5.643; p < 0.01). Furthermore, for VPIs delivered under GA, a prolonged interval from skin incision to fetus delivery was associated with a lower 5-min Apgar score (p < 0.01). Conclusion This study revealed the significant impact of GA on adverse outcomes among VPIs. In cases when GA is required, proactive measures should be instituted for the care of VPIs such as expediting the interval from skin incision to fetal delivery.
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Affiliation(s)
- Lijun Wang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chengxiao Liu
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaokang Wang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Sha Zhu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ligong Zhang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Bo Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Kesavankutty MP, Panda C, Karim HMR, Singha S, Agrawal S. The diagnostic accuracy of preoperative perfusion index as a predictor of postspinal anesthesia hypotension in parturients undergoing cesarean delivery: A prospective non-blinded observational study. Saudi J Anaesth 2024; 18:23-30. [PMID: 38313707 PMCID: PMC10833017 DOI: 10.4103/sja.sja_378_23] [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: 05/08/2023] [Accepted: 06/06/2023] [Indexed: 02/06/2024] Open
Abstract
Background and Objectives Spinal anesthesia is the technique of choice for elective cesarean section with a prominent side effect of postspinal anesthesia hypotension (PSH). This needs an early prediction to avoid feto-maternal complication. This study aimed to assess the diagnostic accuracy of perfusion index (PI) and inferior vena cava collapsibility index (IVCCI) in the prediction of PSH. Material and Methods Thirty parturients of American Society of Anesthesiologists Physical Status (ASA-PS) 1 and two undergoing cesarean delivery participated in the study. IVCCI, PI, baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and heart rate (HR) were noted in the preoperative period. The fall of MBP by 20% from baseline or below 65 mm Hg was considered PSH. After spinal anesthesia, SBP, DBP, MBP, and HR were noted again for diagnosing PSH. Results It did not show any statistical difference when comparing the PI between the PSH and non-PSH groups in both the PSH definition groups. IVCCI was significantly higher when PSH was considered MBP <65 mm Hg (P = 0.01). However, IVCCI was found to be statistically insignificant if PSH was considered a 20% reduction in baseline MBP. The correlation matrix between IVCCI and PI showed Pearson's r-value of 0.525, indicating a substantial relationship between the two (P = 0.003). Multivariate logistic regression analysis had shown that neither IVCCI nor PI was a good predictor of PSH in parturients for both definition groups for PSH. Conclusion Although there is a modest correlation between PI and IVCCI, both cannot be used to predict postspinal hypotension in parturients undergoing elective lower-segment cesarean section (LSCS).
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Affiliation(s)
- Manu P. Kesavankutty
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Chinmaya Panda
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Habib M. R. Karim
- Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subrata Singha
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Sarita Agrawal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Antończyk A, Kiełbowicz Z, Niżański W, Ochota M. Preliminary study on fluid bolus administration for prevention of spinal hypotension in dogs undergoing elective cesarean section. Front Vet Sci 2023; 10:1112845. [PMID: 37026101 PMCID: PMC10072328 DOI: 10.3389/fvets.2023.1112845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction This study aimed to investigate the effect of fluid bolus administration during epidural anesthesia (coload) in female dogs scheduled for elective cesarean section (CS). Hypotension is one of the most common complications of epidural (EA) and spinal (SA) analgesia, and in the case of cesarean section, it may pose a significant risk for placental perfusion and subsequent fetal vitality and puppy survival. Methods Pregnant bitches scheduled for elective CS underwent EA with (treatment group) or without (control group) intravenous fluid bolus administration. The following parameters were measured and compared between both groups: HR, RR, etCO2, SpO2, systolic, diastolic and mean arterial blood pressure were measured at three time points (T1: before surgery, T2: after the last puppy removal, and T3: end of surgery) in dams; vitality (Apgar score at 0, 5, and 20 min) and umbilical cord blood parameters (pH, pCO2, HCO3, base excess, lactate and glucose) in newborns. Results The results indicated that crystalloid coloading increased maternal systolic, diastolic, and mean blood pressure (treatment vs. control group, 101.46 ± 9.18, 48.01 ± 13.47, and 67.07 ± 13.15 mmHg vs. 80.68 ± 7.29, 36.52 ± 8.75, and 180 52.30 ± 7.77, p < 0.05) with significantly fewer episodes of hypotension. Additionally, puppies in the treatment group received higher scores in the 5-min (7.91 ± 1.67 vs. 6.74 ± 2.20) and 20-min (9.38 ± 0.87 vs. 8.39 ± 2.50) assessments without the favorable effect on umbilical blood gas parameters. Discussion Based on the obtained results, it can be stated that crystalloid coload offers an effective option in cases of hypotension during cesarean section, with clear benefits for both mothers and newborns.
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Affiliation(s)
- Agnieszka Antończyk
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
- *Correspondence: Agnieszka Antończyk
| | - Zdzisław Kiełbowicz
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Wojciech Niżański
- Department of Reproduction and Clinic of Farm Animals, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Małgorzata Ochota
- Department of Reproduction and Clinic of Farm Animals, Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
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Kim MS, Kim H, Seo Y, Yum SK. Non-reassuring fetal status and anesthetic impact on cesarean section-delivered very-low-birthweight infants. Pediatr Int 2022; 64:e15308. [PMID: 36198389 DOI: 10.1111/ped.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is limited evidence concerning the impact on neonatal outcomes of different types of anesthesia used for cesarean delivery due to non-reassuring fetal status (NRFS). We aimed to assess the impact of NRFS and general anesthesia (GA) on neonatal outcomes in very-low-birthweight (VLBW) infants delivered by cesarean section. METHODS Data were collected relating to VLBW infants admitted to our institution. Infants were grouped into no-NRFS and NRFS groups and further subcategorized into GA and regional anesthesia (RA) subgroups. Neonatal outcomes were evaluated based on the presence of NRFS and the type of anesthesia. RESULTS A total of 356 infants were included. The GA subgroup in the no-NRFS group had higher requirements for respiratory support. However, GA was not associated with adverse neonatal outcomes based on the multivariable logistic regression analysis except for 5 min Apgar score <5. On the other hand, NRFS was associated with an increased risk of 5 min Apgar score <5 [adjusted odds ratio (aOR) 2.062, 95% confidence interval (CI) 1.064-3.997], use of high-frequency ventilation (aOR: 2.891, 95% CI: 1.477-5.658), and pulmonary hypertension (aOR: 2.890, 95% CI: 1.436-5.819). CONCLUSIONS In our cohort of VLBW infants, NRFS was a significant risk factor for a low 5 min Apgar score, increased respiratory support requirement, and pulmonary hypertension. Accurate assessment of fetal well-being, timely delivery, and presence of a resuscitation team fully aware of perinatal conditions and anesthetic impact is important.
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Affiliation(s)
- Min Soo Kim
- Department of Pediatrics 1College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - HyoYun Kim
- Department of Pediatrics 1College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yumi Seo
- Department of Pediatrics 1College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sook Kyung Yum
- Department of Pediatrics 1College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:18-27. [PMID: 33642943 PMCID: PMC7902754 DOI: 10.1007/s40140-021-00437-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW The use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this review, we will discuss clinical scenarios and risk factors associated with general anesthesia for cesarean delivery and address reasons why anesthesiologists should apply strategies to minimize its use. RECENT FINDINGS Unnecessary general anesthesia for cesarean delivery is associated with maternal complications, including serious anesthesia-related complications, surgical site infection, and venous thromboembolic events. Racial and socioeconomic disparities and low-resource settings are major contributing factors in the use of general anesthesia for cesarean delivery, with both maternal and perinatal mortality increasing when general anesthesia is provided. In addition, more significant maternal pain and higher rates of postpartum depression requiring hospitalization are associated with general anesthesia for cesarean delivery. SUMMARY Rates of general anesthesia for cesarean delivery have overall decreased, and while general anesthesia no longer is a contributing factor to anesthesia-related maternal deaths, further opportunities to reduce its use should be emphasized. Raising awareness in identifying situations and patients at risk to help avoid unnecessary general anesthesia remains crucial.
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Affiliation(s)
- Laurence Ring
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA USA
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ÇAKIR U, YİLDİZ D, KAHVECİOGLU D, OKULU E, ALAN S, ERDEVE O, ARSAN S, ATASAY B. Obstetrik anestezi yöntemlerinin preterm bebeklerde gastrointestinal sistem fonksiyonu üzerine etkisi var mı? CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.627506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Cesarean section (CS) is a common surgical procedure worldwide. The anesthesiologist is responsible, together with obstetrician and neonatologist, for safe perioperative management. A continuum of risk exists for urgent CS. The decision-to-delivery interval is an important audit tool, to ensure international standards are upheld and good outcomes for mother and neonate are achieved. Urgent CS may be performed under either GA or RA, with benefits and risks attributable to each. Specific clinical scenarios require an individualized approach to anesthesia, including hemorrhage, hypertensive disorders, cardiac disease, the difficult airway and fetal compromise. Ongoing training is integral to the provision of safe anesthesia.
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Affiliation(s)
- Nicole L Fernandes
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, D23 Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Robert A Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, D23 Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7925, South Africa.
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Antihypotensiva bei Kaiserschnittentbindungen. Anaesthesist 2019; 68:228-238. [DOI: 10.1007/s00101-019-0560-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/01/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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Thangaswamy CR, Kundra P, Velayudhan S, Aswini LN, Veena P. Influence of anaesthetic technique on maternal and foetal outcome in category 1 caesarean sections - A prospective single-centre observational study. Indian J Anaesth 2018; 62:844-850. [PMID: 30532319 PMCID: PMC6236792 DOI: 10.4103/ija.ija_406_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: In category 1 caesarean section (CS), there is limited evidence regarding superior anaesthetic technique. Hence, this study was designed to study the influence of anaesthetic technique on the maternal and foetal outcome. Methods: Patient characteristics, indication for CS, decision-to-delivery interval (DDI), uterine incision-to-delivery time (UIDT), cord blood pH, Apgar scores and neonatal and maternal outcome were noted. Composite endpoint (Apgar score <7, umbilical cord blood pH <7.2, neonatal intensive care unit admission or death) was created for adverse neonatal outcome. Logistic regression was done to assess the influence of confounding factors on the occurrence of adverse neonatal outcome. Results: Of 123 patients who underwent category 1 cesarean section, 114 patients were included for analysis. The DDI and UIDT were comparable. One and 5-min Apgar scores were significantly lower in the group general anaesthesia (GA) than in the group spinal anaesthesia (SA). The umbilical cord blood pH was comparable (7.21 ± 0.15 vs 7.25 ± 0.11 in groups GA and SA, respectively). Neonatal intensive care admission and maternal outcome were comparable in both the groups. Subgroup analysis of patients with foetal heart rate of less than 100 showed that group GA had significantly lower 1-min Apgar scores and umbilical cord blood pH and significantly more neonatal admission and mortality. Binominal logistic regression showed that group GA (odds ratio 2.9, 95% confidence intervals 1.27-6.41) and gestational age were independently associated with adverse neonatal outcome. Conclusion: GA for category 1 CS was associated with increased incidence of adverse neonatal outcome.
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Affiliation(s)
- Chitra Rajeswari Thangaswamy
- Departments of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | - Pankaj Kundra
- Departments of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | - Savitri Velayudhan
- Department of Anaesthesiology and Critical Care, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
| | | | - P Veena
- Department of Obstetrics and Gynaecology Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry Institute of Medical Sciences, Puducherry, Tamil Nadu, India
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Ayebale ET, Kwizera A, Mijumbi C, Kizito S, Roche AM. Ringer's Lactate Versus Normal Saline in Urgent Cesarean Delivery in a Resource-Limited Setting: A Pragmatic Clinical Trial. Anesth Analg 2017; 125:533-539. [PMID: 28682955 DOI: 10.1213/ane.0000000000002229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Crystalloids are used routinely for perioperative fluid management in cesarean delivery. Few studies have determined the crystalloid of choice in obstetric anesthesia. We compared the effects of Ringer's lactate (RL) versus 0.9% normal saline (NS) on maternal and neonatal blood pH and 24-hour postoperative morbidity in urgent cesarean delivery in a low-resource setting. Our hypothesis was that RL would result in 30% less acidosis than NS. METHODS This was a pragmatic prospective double-blind randomized controlled trial in the Mulago National Referral Hospital Labor Ward Theater from September 2011 to May 2012. Five hundred parturients were studied; 252 were randomly assigned to NS and 248 to RL groups. Preoperative and postoperative maternal venous blood gases and placental umbilical arterial cord blood gases were analyzed. The primary outcome was incidence of maternal acidosis, as defined by a postoperative drop in venous pH below 7.32 or reduction in base excess below -3 in a previously normal parturient. Maternal 24-hour postoperative morbidity, neonatal pH, and neonatal base excess were the main secondary outcomes. The study was registered in ClinicalTrials.gov as NCT01585740. RESULTS The overall incidence of maternal acidosis was 38% in NS and 29% in RL (relative risk, 1.29; 95% confidence interval, 1.01-1.66; P = .04). Thirty-two percent of parturients in NS experienced a drop in venous pH below 7.32 postoperatively, compared with 19% in RL (relative risk, 1.65; 95% confidence interval, 1.18-2.31; P = .003). The comparative drop in base excess postoperatively below -3 between the 2 groups was not statistically significant. There were no significant differences in the incidence of maternal 24-hour postoperative morbidity events and neonatal outcomes between the 2 groups. CONCLUSIONS NS may be a safe choice for intraoperative fluid therapy in urgent cesarean delivery as RL, albeit with an increased incidence of metabolic acidosis.
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Affiliation(s)
- Emmanuel Timarwa Ayebale
- From the *Department of Anesthesia, Makerere University College of Health Sciences, Kampala, Uganda; †Department of Anesthesia, Mulago National Referral Hospital, Kampala, Uganda; ‡Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda; and §Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Samanta S, Jain K, Bhardwaj N, Jain V, Samanta S, Saha R. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies. Indian J Anaesth 2016; 60:115-20. [PMID: 27013750 PMCID: PMC4787122 DOI: 10.4103/0019-5049.176282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND AIMS Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. METHODS Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E) group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7-15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T) group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4-6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. RESULTS Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001) regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. CONCLUSION Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.
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Affiliation(s)
- Sukhen Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neerja Bhardwaj
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Jain
- Department of Obstetric and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujay Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rini Saha
- Department of Ophthalmology, ASG Eye Hospital, Jodhpur, Rajasthan, India
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Wong CA. Anaesthesia for preterm Caesarean delivery: is it different from term deliveries? Br J Anaesth 2015; 115:166-8. [PMID: 26170344 DOI: 10.1093/bja/aev231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C A Wong
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, F5-704, Chicago, IL, USA
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Butwick AJ, El-Sayed YY, Blumenfeld YJ, Osmundson SS, Weiniger CF. Mode of anaesthesia for preterm Caesarean delivery: secondary analysis from the Maternal-Fetal Medicine Units Network Caesarean Registry. Br J Anaesth 2015; 115:267-74. [PMID: 25956901 DOI: 10.1093/bja/aev108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Preterm delivery is often performed by Caesarean section. We investigated modes of anaesthesia and risk factors for general anaesthesia among women undergoing preterm Caesarean delivery. METHODS Women undergoing Caesarean delivery between 24(+0) and 36(+6) weeks' gestation were identified from a multicentre US registry. The mode of anaesthesia was classified as neuraxial anaesthesia (spinal, epidural, or combined spinal and epidural) or general anaesthesia. Logistic regression was used to identify patient characteristic, obstetric, and peripartum risk factors associated with general anaesthesia. RESULTS Within the study cohort, 11 539 women had preterm Caesarean delivery; 9510 (82.4%) underwent neuraxial anaesthesia and 2029 (17.6%) general anaesthesia. In our multivariate model, African-American race [adjusted odds ratio (aOR)=1.9; 95% confidence interval (CI)=1.7-2.2], Hispanic ethnicity (aOR=1.5; 95% CI=1.2-1.8), other race (aOR=1.4; 95% CI=1.1-1.9), and haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome or eclampsia (aOR=2.8; 95% CI=2.2-3.5) were independently associated with receiving general anaesthesia for preterm Caesarean delivery. Women with an emergency Caesarean delivery indication had the highest odds for general anaesthesia (aOR=3.5; 95% CI=3.1-3.9). For every 1 week decrease in gestational age at delivery, the adjusted odds of general anaesthesia increased by 13%. CONCLUSIONS In our study cohort, nearly one in five women received general anaesthesia for preterm Caesarean delivery. Although potential confounding by unmeasured factors cannot be excluded, our findings suggest that early gestational age at delivery, emergent Caesarean delivery indications, hypertensive disease, and non-Caucasian race or ethnicity are associated with general anaesthesia for preterm Caesarean delivery.
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Affiliation(s)
- A J Butwick
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Y Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Y J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - S S Osmundson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - C F Weiniger
- Department of Anaesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Saygı Aİ, Özdamar Ö, Gün İ, Emirkadı H, Müngen E, Akpak YK. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial. SAO PAULO MED J 2015; 133:227-34. [PMID: 26176927 PMCID: PMC10876380 DOI: 10.1590/1516-3180.2014.8901012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 05/05/2014] [Accepted: 10/20/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section. DESIGN AND SETTING Prospective randomized controlled clinical trial in a tertiary-level public hospital. METHODS Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups. RESULTS Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group. CONCLUSION In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.
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Affiliation(s)
- Anıl İçel Saygı
- MD. Attending Physician, Department of Obstetrics and Gynecology, Ankara Military Hospital, Ankara, Turkey.
| | - Özkan Özdamar
- MD. Attending Physician, Department of Obstetrics and Gynecology, Gölcük Military Hospital, Gölcük, Kocaeli, Turkey.
| | - İsmet Gün
- MD. Associate Professor, Department of Obstetrics and Gynecology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
| | - Hakan Emirkadı
- MD. Attending Physician, Department of Anesthesiology and Reanimation, Gölcük Military Hospital, Gölcük, Kocaeli, Turkey.
| | - Ercüment Müngen
- MD. Professor, Department of Obstetrics and Gynecology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
| | - Yaşam Kemal Akpak
- MD. Attending Physician, Department of Obstetrics and Gynecology, Ankara Military Hospital, Ankara, Turkey.
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Strouch Z, Dakik C, White W, Habib A. Anesthetic technique for cesarean delivery and neonatal acid–base status: a retrospective database analysis. Int J Obstet Anesth 2015; 24:22-9. [DOI: 10.1016/j.ijoa.2014.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 10/31/2014] [Accepted: 11/09/2014] [Indexed: 11/16/2022]
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16
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Affiliation(s)
- Yusuke Mazda
- Saitama Medical Center, Saitama Medical University; Division of Obstetric Anesthesia, Department of Anesthesiology; 1981 Kamoda Kawagoe Saitama Japan 350-8550
| | - Erika Ota
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Rintaro Mori
- National Center for Child Health and Development; Department of Health Policy; 2-10-1 Okura, Setagaya-ku Tokyo Japan 157-8535
| | - Katsuo Terui
- Saitama Medical Center, Saitama Medical University; Division of Obstetric Anesthesia, Department of Anesthesiology; 1981 Kamoda Kawagoe Saitama Japan 350-8550
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17
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Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia. J Pregnancy 2014; 2014:325098. [PMID: 24864211 PMCID: PMC4016895 DOI: 10.1155/2014/325098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/05/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022] Open
Abstract
This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA).
Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.
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18
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Perrotin F, Simon E, Potin J, Laffon M. Modalités de naissance du fœtus porteur d’un RCIU. ACTA ACUST UNITED AC 2013; 42:975-84. [DOI: 10.1016/j.jgyn.2013.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Maternal Hypotension During Spinal Anesthesia for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2013. [DOI: 10.1007/s40140-013-0036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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A randomised comparison of the effects of low-dose spinal or general anaesthesia on umbilical cord blood gases during caesarean delivery of growth-restricted foetuses with impaired Doppler flow. Eur J Anaesthesiol 2013; 30:9-15. [DOI: 10.1097/eja.0b013e3283564698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Anaesthesia for caesarean delivery of growth-restricted foetuses: a bird in the hand is worth two in the bush. Eur J Anaesthesiol 2012; 30:5-6. [PMID: 23222366 DOI: 10.1097/eja.0b013e328357659b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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23
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Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg 2011; 114:377-90. [PMID: 22104076 DOI: 10.1213/ane.0b013e3182373a3e] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Phenylephrine is effective for the management of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery under spinal anesthesia. While ephedrine was previously considered the vasopressor of choice in obstetric patients, phenylephrine is increasingly being used. This is largely due to studies suggesting improved fetal acid-base status with the use of phenylephrine as well as the low incidence of hypotension and its related side effects with prophylactic phenylephrine regimens. This review highlights the effects of phenylephrine compared with ephedrine on maternal hemodynamics (arterial blood pressure, heart rate, and cardiac output), and occurrence of intraoperative nausea and vomiting. The impact of the administration of phenylephrine as a bolus for the treatment of established hypotension compared with its administration as a prophylactic infusion is discussed. This article also reviews the impact of phenylephrine compared with ephedrine on uteroplacental perfusion, and fetal outcomes such as neonatal acid-base status and Apgar scores. The optimum dosing regimen for phenylephrine administration is also discussed.
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Affiliation(s)
- Ashraf S Habib
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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24
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Mercier FJ. [Prevention and treatment of hypotension during spinal anesthesia for elective caesarean section: any progress in clinical practice?]. ACTA ACUST UNITED AC 2011; 30:622-4. [PMID: 21868191 DOI: 10.1016/j.annfar.2011.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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25
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Abstract
The current article covers some of the major themes that emerged in 2009 in the fields of obstetric anesthesiology, obstetrics, and perinatology, with a special emphasis on the implications for the obstetric anesthesiologist.
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Affiliation(s)
- J M Mhyre
- Department of Anesthesia, Division of Obstetric Anesthesia, Women's Hospital, University of Michigan Health System, Ann Arbor, MI 48109-5278, USA.
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