1
|
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.
Collapse
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
| |
Collapse
|
2
|
Numerous Confounders Affecting the Alleged Association Between Cesarean Deliveries Under General Anesthesia and Autism Spectrum Disorder. J Autism Dev Disord 2019; 50:688-690. [PMID: 31673911 DOI: 10.1007/s10803-019-04247-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
3
|
Gal O, Rotshtein M, Feldman D, Mari A, Hallak M, Kopelman Y. Estimation of Gastric Volume Before Anesthesia in Term-Pregnant Women Undergoing Elective Cesarean Section, Compared With Non-pregnant or First-Trimester Women Undergoing Minor Gynecological Surgical Procedures. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2019; 12:1179562X19828372. [PMID: 30899153 PMCID: PMC6419245 DOI: 10.1177/1179562x19828372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events. AIMS Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. METHODS In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure. RESULTS Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm2 vs 3.2 ± 0.79 cm2; P = .97). Gastric volume was small in the two groups. CONCLUSION Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.
Collapse
Affiliation(s)
- Oren Gal
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Mark Rotshtein
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetric Anesthesia Unit, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dan Feldman
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Amir Mari
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Motti Hallak
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
- Obstetric and Gynecology Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yael Kopelman
- Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
4
|
Lalmand M, Wilwerth M, Fils JF, Van der Linden P. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study. Anesth Analg 2017; 125:907-912. [PMID: 28368941 DOI: 10.1213/ane.0000000000001892] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND After cesarean delivery, postoperative pain management allows early rehabilitation and helps prevent postpartum depression and chronic pain. Our present prospective, randomized controlled, double-blind study assessed the duration and effect of intrathecal analgesia and continuous ropivacaine wound infiltration versus a control group after cesarean delivery. The primary outcome was analgesia duration, defined as time to first morphine request. Secondary outcomes were cumulative postoperative morphine consumption, number of patients who did not require IV morphine, incidence of adverse effects, and time to first ambulation. METHODS A total of 192 full-term parturients undergoing elective cesarean delivery were randomly allocated into 3 groups (control, morphine, and catheter). All patients received spinal anesthesia with 10 mg bupivacaine 0.5% hyperbaric bupivacaine (2 mL) + 5 μg of sufentanil (1 mL) and a multiholed catheter inserted into the wound. In the control group, NaCl 0.9% was administered intrathecally (0.1 mL) and through the catheter. The morphine group received 100 μg morphine (0.1 mL) intrathecally and NaCl 0.9% infused through the wound catheter. The catheter group received 0.1 mL NaCl 0.9% intrathecally and ropivacaine 0.2% infused in the catheter. Each patient received a 15-mL bolus of the dedicated solution through the catheter, which was connected to an elastomeric pump infusor delivering the same solution at a rate of 10 mL/h for 30 hours. All patients also received multimodal analgesia including acetaminophen and diclofenac. Analgesia duration was defined as the time from spinal injection (T0) to first IV morphine requirement (T1) administered via a patient-controlled IV analgesia pump. Statistical data analyses included use of the Kruskal-Wallis rank-sum test followed by the post hoc Tukey test and χ test. RESULTS The duration of postoperative analgesia was increased with intrathecal morphine (380 minutes; 215-1527) and ropivacaine wound infusion (351 minutes; 227-594) compared with the control (247 minutes; 182-338) with effect sizes of 0.171 (0.043-0.293) for morphine versus control and 0.164 (0.052-0.271) for catheter versus control. There was no difference between the morphine group and catheter group (effect size, 0.007; -0.118 to 0.132). Cumulative postoperative morphine consumption was also significantly lower in the morphine group and catheter group compared with the control group. The incidence of adverse effects did not differ between groups. CONCLUSIONS After elective cesarean delivery, 100 μg intrathecal morphine and ropivacaine wound infusion both increased the duration and effect of postcesarean analgesia without increased incidence of side effects.
Collapse
Affiliation(s)
- Manon Lalmand
- From the *Department of Anesthesiology, Université Libre de Bruxelles, Centre Hospitalier Universitaire Brugmann, Place Van Gehuchten, Brussels, Belgium; and †Ars Statistica, Nivelles, Belgium
| | | | | | | |
Collapse
|
5
|
Wilwerth M, Majcher JL, Van der Linden P. Spinal fentanyl vs. sufentanil for post-operative analgesia after C-section: a double-blinded randomised trial. Acta Anaesthesiol Scand 2016; 60:1306-13. [PMID: 27137756 DOI: 10.1111/aas.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/15/2016] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fentanyl and sufentanil are the most commonly administered intrathecal lipophilic opioids worldwide, although their relative efficacy when given by this route is not well characterised. The primary endpoint of this prospective, randomised, double-blind study was to compare effective analgesia duration of intrathecal administered fentanyl 25 μg and sufentanil 2.5 or 5 μg, Second endpoints were to compare post-operative morphine consumption and incidence of side effects between these opioids dosages. METHODS After IRB approval, 180 full-term parturients undergoing elective Caesarean section were randomly allocated into three groups, according to the opioid added to 10 mg intrathecal hyperbaric bupivacaine: fentanyl 25 μg, sufentanil 2.5 μg or sufentanil 5 μg. Total effective analgesia was defined as time from spinal injection (T0) to first IV morphine requirement (T1) administered with a patient controlled intravenous pump. Statistical data analysis included non-parametric tests and chi-squared. A P value < 0.05 was considered statistically significant. Data are presented as median [interquartile ranges 25-75]. RESULTS Duration of analgesia was significantly longer with sufentanil 2.5 μg (214 min [189-251]) and 5 μg (236 min [190-372]) compared to fentanyl 25 μg (187 min [151-230]) (P < 0.01). Morphine consumption at T1 + 4 h was lower in the sufentanil groups (6 mg [3-9] and 6 mg [2-10]) than in the fentanyl group (9 mg [5-13]) (P < 0.01). Incidence of adverse effects was not different between groups. CONCLUSION In the conditions of our study, sufentanil 5 μg was the opioid of choice, associated with the best quality of anaesthesia without increased incidence of side effects.
Collapse
Affiliation(s)
- M. Wilwerth
- Department of Anaesthesiology; University Hospital Brugmann; Université Libre de Bruxelles; Brussels Belgium
| | - J.-L. Majcher
- Department of Anaesthesiology; University Hospital Brugmann; Université Libre de Bruxelles; Brussels Belgium
| | - P. Van der Linden
- Department of Anaesthesiology; University Hospital Brugmann; Université Libre de Bruxelles; Brussels Belgium
| |
Collapse
|
6
|
Ioscovich A, Mirochnitchenko E, Halpern SH, Smueloff A, Grisaru-Granovsky S, Gozal Y, Einav S. Anesthetic considerations for high order cesarean sections: a prospective cohort study. Arch Gynecol Obstet 2013; 289:533-40. [DOI: 10.1007/s00404-013-3008-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 08/08/2013] [Indexed: 11/25/2022]
|
7
|
Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 425:191-198. [PMID: 22482785 PMCID: PMC3563327 DOI: 10.1016/j.scitotenv.2012.03.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/01/2012] [Accepted: 03/06/2012] [Indexed: 05/31/2023]
Abstract
This study introduces life cycle assessment as a tool to analyze one aspect of sustainability in healthcare: the birth of a baby. The process life cycle assessment case study presented evaluates two common procedures in a hospital, a cesarean section and a vaginal birth. This case study was conducted at Magee-Womens Hospital of the University of Pittsburgh Medical Center, which delivers over 10,000 infants per year. The results show that heating, ventilation, and air conditioning (HVAC), waste disposal, and the production of the disposable custom packs comprise a large percentage of the environmental impacts. Applying the life cycle assessment tool to medical procedures allows hospital decision makers to target and guide efforts to reduce the environmental impacts of healthcare procedures.
Collapse
Affiliation(s)
- Nicole Campion
- University of Pittsburgh, 949 Benedum Hall, Pittsburgh, PA 15261, United States of America
| | - Cassandra L. Thiel
- University of Pittsburgh, 949 Benedum Hall, Pittsburgh, PA 15261, United States of America
| | - Justin DeBlois
- University of Pittsburgh, 949 Benedum Hall, Pittsburgh, PA 15261, United States of America
| | - Noe C. Woods
- Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15235, United States of America
| | - Amy E. Landis
- Arizona State University, P.O. Box 875306, Tempe, AZ 85287-5306, United States of America
| | - Melissa M. Bilec
- University of Pittsburgh, 949 Benedum Hall, Pittsburgh, PA 15261, United States of America
| |
Collapse
|
8
|
Birnbach DJ, Bucklin BA, Dexter F. Impact of anesthesiologists on the incidence of vaginal birth after cesarean in the United States: role of anesthesia availability, productivity, guidelines, and patient safety. Semin Perinatol 2010; 34:318-24. [PMID: 20869547 DOI: 10.1053/j.semperi.2010.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The rate of vaginal birth after cesarean delivery (VBAC) has been steadily decreasing in the United States. What is not clear, however, is what part the availability of anesthesia personnel has played in this reduction. We review the role of anesthesia services in the trend of the decreasing rates of VBAC. Three areas of particular interest to anesthesiology services are addressed: (1) the current ability of anesthesiologists in the United States to provide "immediate" availability for VBAC at all delivery locations; (2) the workforce estimates for anesthesiology staffing in the future; and (3) the barriers to the immediate availability of anesthesiologists in all hospitals that provide obstetrical care. The concept of "immediate availability" is discussed, and examples of ways to reduce the risks to patients are provided. Finally, possible solutions that may improve patient safety without a dramatic increase in number of anesthesiologists available to work on labor and delivery units are highlighted.
Collapse
Affiliation(s)
- David J Birnbach
- UM-JMH Center for Patient Safety, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
| | | | | |
Collapse
|
9
|
Kinsella SM, Girgirah K, Scrutton MJL. Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case series. Anaesthesia 2010; 65:664-9. [DOI: 10.1111/j.1365-2044.2010.06368.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|