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Naoum EE, O'Neil ER, Shamshirsaz AA. Extracorporeal membrane oxygenation (ECMO) in pregnancy and peripartum: a focused review. Int J Obstet Anesth 2024:104247. [PMID: 39209576 DOI: 10.1016/j.ijoa.2024.104247] [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: 02/26/2024] [Revised: 07/06/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
As the medical complexity of pregnant patients increases, the rate of maternal morbidity has risen. Maternal cardiovascular disease is a leading cause of maternal morbidity and mortality followed closely by sepsis and infection, both of which may be associated with respiratory failure. There has been an expansion in the application of extracorporeal life support in pregnant and peripartum patients which requires obstetric anesthesiologists to understand the indications, obstetric and medical considerations, relative advantages and potential complications of this invasive technology in this population. Obstetricians and anesthesiologists who care for women on the labor floor must strive to recognize at-risk and deteriorating patients, facilitate escalation of care when appropriate, and engage consultant teams to consider the need for extracorporeal support in high-risk circumstances. This article reviews the epidemiology, indications, specific considerations, potential complications, and outcomes of extracorporeal life support in pregnant and peripartum patients.
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Affiliation(s)
- Emily E Naoum
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Erika R O'Neil
- Department of Pediatrics, United States Air Force, Brooke Army Medical Center, San Antonio TX, USA
| | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Texas Children's Hospital, Houston, TX, USA; Department of Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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Maxwell S, Rajala B, Schechtman SA, Kountanis JA, Singh S, Klumpner TT, Cassidy R, Zisblatt L, Healy DW, Engoren M, Cooke JM, Pancaro C. Development of the obstetric unanticipated difficult video-laryngoscopy algorithm through a quality improvement randomized open-label in situ simulation study. Int J Obstet Anesth 2024; 60:104245. [PMID: 39236438 DOI: 10.1016/j.ijoa.2024.104245] [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: 02/28/2024] [Revised: 07/08/2024] [Accepted: 07/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Video-laryngoscopy is increasingly used during general anesthesia for emergency cesarean deliveries. Given the heightened risk of difficult tracheal intubation in obstetrics, addressing challenges in airway management is crucial. In this simulation study, we hypothesized that using a flexible bronchoscope would lead to securing the airway faster than the Eschmann introducer when either device is used in addition to video-laryngoscopy. METHODS Twenty-eight anesthesia trainees (n=14/group) were randomized to use either one of the rescue devices and video-recorded in a simulated scenario of emergency cesarean delivery. The primary outcome was the time difference in establishing intubation; secondary outcomes were the differences in incidence of hypoxemia, need for bag and mask ventilation, and failed intubation between the two rescue devices. RESULTS Mean (±SD) time to intubation using flexible bronchoscopy was shorter compared to using an Eschmann introducer (24 ± 10 vs 86 ± 35 s; P<0.0001; difference in mean 62 seconds, 95% CI 42 to 82 seconds). In the fiberoptic bronchoscopy group, there were no episodes of hypoxemia or need for bag and mask ventilation; in contrast both such events occurred frequently in the Eschmann introducer group (71%, 10/14); P=0.0002). All flexible bronchoscopy-aided intubations were established on the first attempt. The incidence of failed intubation was similar in both groups. CONCLUSIONS Our data from simulated emergency tracheal intubation suggest that flexible bronchoscopy combined with video-laryngoscopy results in faster intubation time than using an Eschmann introducer combined with video-laryngoscopy.
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Affiliation(s)
- S Maxwell
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - B Rajala
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - S A Schechtman
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - J A Kountanis
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - S Singh
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - T T Klumpner
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - R Cassidy
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - L Zisblatt
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - D W Healy
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - M Engoren
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - J M Cooke
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States
| | - C Pancaro
- Departments of Anesthesiology, Obstetrics and Gynecology and Family Medicine & Learning Health Sciences, University of Michigan Medical School, United States.
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Thomas CL, Montes M, Malik T, Sandeep Ram B, Smith CL, Scavone BM, Cole NM. A Case Report of Fluoroscopically Guided Epidural Catheter Placement in a Parturient with History of Tethered Cord, Super-Morbid Obesity, and Risk for Difficult Airway. A A Pract 2024; 18:e01777. [PMID: 38587314 DOI: 10.1213/xaa.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Tethered cord syndrome results from adherence of the conus medullaris to the sacrum and may be associated with high complication rates from neuraxial anesthesia. We present the case of a 32-year-old gravida 2 para 0 patient with a history of lipomyelomeningocele (one of several types of spina bifida) and tethered cord status post repair, residual low-lying conus medullaris, supermorbid obesity (body mass index of 58), and Mallampati IV airway, who underwent successful fluoroscopically guided epidural catheter placement for vaginal delivery. Risks and benefits of epidural catheter utilization and methods of placement are reviewed.
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Affiliation(s)
- Caroline L Thomas
- From the Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Chan J, Chan C, Chia P, Goy R, Sng BL. Novice learners' perspectives on obstetric airway crisis decision-making training using virtual reality simulation. Int J Obstet Anesth 2024; 57:103926. [PMID: 37866972 DOI: 10.1016/j.ijoa.2023.103926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/08/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Current training on managing an obstetric difficult airway crisis is likely inadequate, as real-life opportunities to practice are rare. Frequent simulation training sessions could be helpful but are resource intensive. Virtual reality (VR) simulation training may be a potential tool to complement existing simulation curricula. METHODS In this pilot qualitative study, a VR simulation scenario of an obstetric airway crisis was designed to test the decision-making of novice learners rotating through obstetric anesthesia training. Individual interviews were conducted pre-VR to assess learning needs and post-VR to assess perspectives on utilizing the VR teaching tool. The interviews were transcribed and thematically analyzed. RESULTS Twenty-one residents were recruited and participated in the study. Analysis of pre-VR interviews identified three major themes, including gaps in the current curriculum, lack of confidence in managing obstetric difficult airway crises, and recognition that simulation is resource intensive. Post-VR interview themes revealed that VR could be helpful in learning decision-making under stress. Suggested improvements included better video and audio quality, and adding haptic feedback and potential multiplayer features in the future. CONCLUSION We identified the advantages of VR simulation and its potential as an intervention to address gaps in our curriculum. Areas of improvement were identified for more effective future implementation.
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Affiliation(s)
- J Chan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | - C Chan
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - P Chia
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - R Goy
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
| | - B L Sng
- Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore
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Neuman MD, Lim G, Dinh C, Clapp JT. Anesthesiologists' Attitudes Toward Randomization to General versus Neuraxial Anesthesia for Cesarean Delivery. Anesthesiology 2024; 140:170-172. [PMID: 38085157 PMCID: PMC10751982 DOI: 10.1097/aln.0000000000004791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Mark D Neuman
- University of Pennsylvania, Philadelphia, Pennsylvania (M.D.N.).
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Brennan KA, Angelidis IK. Resuscitation in obstetric care. Int Anesthesiol Clin 2023; 61:55-61. [PMID: 37622314 DOI: 10.1097/aia.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Kaitlyn A Brennan
- Department of Anesthesiology & Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennesse
| | - Ioannis K Angelidis
- New York University, Grossman School of Medicine, New York, New York
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
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Gaston IN, Lange EMS, Farrer JR, Toledo P. Sugammadex Use for Reversal in Nonobstetric Surgery During Pregnancy: A Reexamination of the Evidence. Anesth Analg 2023; 136:1217-1219. [PMID: 37205805 DOI: 10.1213/ane.0000000000006442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Ian N Gaston
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth M S Lange
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Jason R Farrer
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paloma Toledo
- From the Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
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Li X, Lian Y, Pan F, Zhao H. Global research trends in prediction of difficult airways: A bibliometric and visualization study. Medicine (Baltimore) 2023; 102:e33776. [PMID: 37171310 PMCID: PMC10174351 DOI: 10.1097/md.0000000000033776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Many tools are used to predict difficult airway, including bedside screening tests, radiological variables, and ultrasonography. However, the "gold standard" to identify difficult airway before intubation has not been established. The assessment and prediction of difficult airway is receiving increasing attention in clinical practice due to the devastating results of failed oxygenation or intubation. A literature visualization study is necessary to understand the research trend and help tailor future research directions. Science citation index-expanded web of Science database were used to search for literature related to assessment and prediction of difficult airways published before May 9th, 2022. VOS viewer software was used for visual analysis, including literature statistics, and co-occurrence analysis. A total of 2609 articles were included. The amount of relevant research interest and literature is increasing every year. According to co-occurrence network analysis, the research results can be grouped into the following 5 clusters, intubation approaches, intubation in special populations, difficult airway assessment tests, intubation in critical care/emergency settings and education, and laryngoscopes. Co-occurrence overlay analysis showed that video laryngoscopes and index prediction (including computed tomography and ultrasonography), emerged recently and comprised an important percentage of current studies. It can be predicted that future studies should focus on understanding the upper airway anatomy and constructing risk index predictions. Based on current global research trends, risk index predictions are the next hot topics in the evaluation and prediction of difficult airways, and video laryngoscopes will continue to be a hot topic in this field.
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Affiliation(s)
- Xiaoyan Li
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Yixiao Lian
- Department of Library, Peking University People's Hospital, Beijing, China
| | - Fang Pan
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Hong Zhao
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
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Bhatia K, D'Souza R, Malhamé I, Thorne S. Anaesthetic considerations in pregnant patients with cardiac arrhythmia. BJA Educ 2023; 23:196-206. [PMID: 37124169 PMCID: PMC10140473 DOI: 10.1016/j.bjae.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- K. Bhatia
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R. D'Souza
- McMaster University, Hamilton, Ontario, Canada
| | - I. Malhamé
- McGill University Health Centre, Montreal, Quebec, Canada
| | - S. Thorne
- University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
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10
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Achu RA, Reale SC. Airway Management in Pregnancy. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Skoog CM, Katzer JF, Wendt LH, Ituk U. The Association of Anesthesia Type and Neonatal Outcomes Following Category-1 Cesarean Delivery: A Retrospective Cohort Study. Cureus 2023; 15:e35910. [PMID: 37033505 PMCID: PMC10081886 DOI: 10.7759/cureus.35910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives Neuraxial anesthesia is the preferred anesthesia technique for cesarean delivery due to a decreased risk of adverse events. However, general anesthesia is often employed during emergent cesarean deliveries to achieve a shorter decision-to-delivery interval. The objective of this study was to determine if the conversion of epidural labor analgesia to surgical anesthesia for a category-1 cesarean delivery is associated with significant neonatal morbidity. Study design This was a retrospective cohort study of all intrapartum category-1 cesarean deliveries performed at an academic tertiary care institution between August 2016 and July 2021. The primary outcome was neonatal morbidity, defined as a composite of neonatal umbilical artery pH < 7.10 and/or 5-min Apgar score < 7, and/or neonatal intensive care unit admission. A multivariate regression analysis was performed to control for the presence of covariates and examine the degree to which they influenced the outcome. Results A total of 185 mother-neonate pairs qualified for inclusion, of which 23 had cesarean delivery under general anesthesia and 162 under epidural anesthesia. There was no significant difference in adverse neonatal outcomes between category-1 cesarean deliveries done under general anesthesia compared to epidural anesthesia (47% vs 35%, p = 0.3). The incidence of umbilical arterial pH < 7.10 was higher in the general anesthesia group compared to the epidural anesthesia group (35% vs 12%, p = 0.018). The multivariate regression model showed that gestational age (OR = 0.63; 95% CI = 0.51-0.75, p = <0.001) and non-reassuring fetal heart trace (OR = 0.18; 95% CI = 0.05-0.58, p = 0.005) were significant predictors of adverse neonatal outcome. Conclusion Our results suggest that the conversion of epidural analgesia to surgical anesthesia for category-1 cesarean delivery in women with a functional labor epidural catheter is not associated with poorer neonatal outcomes.
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Affiliation(s)
- Carl M Skoog
- Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Joel F Katzer
- Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Linder H Wendt
- Institute of Clinical and Translational Research, University of Iowa, Iowa City, USA
| | - Unyime Ituk
- Department of Anesthesia, University of Iowa, Iowa CIty, USA
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Mukasa CDM, Kovacheva VP. Development and implementation of databases to track patient and safety outcomes. Curr Opin Anaesthesiol 2022; 35:710-716. [PMID: 36302209 PMCID: PMC10262595 DOI: 10.1097/aco.0000000000001201] [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] [Indexed: 11/06/2022]
Abstract
PURPOSE OF REVIEW Recent advancements in big data analytical tools and large patient databases have expanded tremendously the opportunities to track patient and safety outcomes.We discuss the strengths and limitations of large databases and implementation in practice with a focus on the current opportunities to use technological advancements to improve patient safety. RECENT FINDINGS The most used sources of data for large patient safety observational studies are administrative databases, clinical registries, and electronic health records. These data sources have enabled research on patient safety topics ranging from rare adverse outcomes to large cohort studies of the modalities for pain control and safety of medications. Implementing the insights from big perioperative data research is augmented by automating data collection and tracking the safety outcomes on a provider, institutional, national, and global level. In the near future, big data from wearable devices, physiological waveforms, and genomics may lead to the development of personalized outcome measures. SUMMARY Patient safety research using large databases can provide actionable insights to improve outcomes in the perioperative setting. As datasets and methods to gain insights from those continue to grow, adopting novel technologies to implement personalized quality assurance initiatives can significantly improve patient care.
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Affiliation(s)
- Christopher D M Mukasa
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Prior CH, Burlinson CEG, Chau A. Emergencies in obstetric anaesthesia: a narrative review. Anaesthesia 2022; 77:1416-1429. [PMID: 36089883 DOI: 10.1111/anae.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
We conducted a narrative review in six areas of obstetric emergencies: category-1 caesarean section; difficult and failed airway; massive obstetric haemorrhage; hypertensive crisis; emergencies related to neuraxial anaesthesia; and maternal cardiac arrest. These areas represent significant research published within the last five years, with emphasis on large multicentre randomised trials, national or international practice guidelines and recommendations from major professional societies. Key topics discussed: prevention and management of failed neuraxial technique; role of high-flow nasal oxygenation and choice of neuromuscular drug in obstetric patients; prevention of accidental awareness during general anaesthesia; management of the difficult and failed obstetric airway; current perspectives on the use of tranexamic acid, fibrinogen concentrate and cell salvage; guidance on neuraxial placement in a thrombocytopenic obstetric patient; management of neuraxial drug errors, local anaesthetic systemic toxicity and unusually prolonged neuraxial block regression; and extracorporeal membrane oxygenation use in maternal cardiac arrest.
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Affiliation(s)
- C H Prior
- Department of Anaesthesia, West Middlesex University Hospital, London, UK
| | - C E G Burlinson
- Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - A Chau
- Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
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Bao Y, Zhang T, Li L, Zhou C, Liang M, Zhou J, Wang C. A retrospective analysis of maternal complications and newborn outcomes of general anesthesia for cesarean delivery in a single tertiary hospital in China. BMC Anesthesiol 2022; 22:208. [PMID: 35794540 PMCID: PMC9258083 DOI: 10.1186/s12871-022-01753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Either neuraxial anesthesia or general anesthesia can be performed for cesarean delivery. Generally, neuraxial anesthesia is the first choice with the risk and benefit balance for both the mother and fetus. However, general anesthesia is also applicable most commonly in the emergent setting. This study analyzed maternal complications associated with general anesthesia for cesarean delivery and suggested lowering pregnancy-related maternal and newborn adverse outcomes. Methods With the approval of the Institutional Ethics Review Board (No: 2017016), data on cesarean delivery and related anesthesia were collected from the Electronic Health Record System from 1/1/2013 to 12/31/2016. Statistical software STATA version 15.1 was used for data analyses. All statistical tests were two-sided, and a level significance of 0.05 was assumed. Results The rate of general anesthesia for cesarean delivery increased steadily during 2013–2016, 3.71% in 2013 to 10.23% in 2016 (p < 0.001). Repeat cesarean delivery among general anesthesia group increased significantly from 16.22% in 2013 to 54.14% in 2016 (p < 0.001). Morbidly adherent placenta (MAP) was the first reason among pregnancy-related complications, which accounted for 33% in total in general anesthesia group (38% in 2013 to 44% in 2016). The laryngeal mask airway (LMA) was used in airway management, and the proportion of LMA increased from 28.38% in 2013 to 92.99% in 2016 (p < 0.001). There were significant differences in newborn outcomes between general anesthesia and neuraxial anesthesia groups, including newborn weight, newborn Apgar score at 1 min and 5 min and newborn admission to the NICU (p < 0.001). Conclusions The growing incidence of general anesthesia was consistent with the trend of rising repeat cesarean delivery and MAP. low newborn Apgar score and high newborn admission to the NICU in general anesthesia group compared with neuraxial anesthesia group. The LMA was performed safely for airway management with enough fasting and careful gastric volume evaluation.
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