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Zheng Y, Zhang L, Wu X, Zhou M. Development and Validation of a Nomogram for the Failed Conversion of Labor Analgesia to Cesarean Section Anesthesia. J Pain Res 2024; 17:197-208. [PMID: 38223662 PMCID: PMC10787563 DOI: 10.2147/jpr.s443338] [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: 10/27/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often encounters failures. This study aimed to develop a nomogram for predicting the failure rate of this conversion. Patients and Methods A retrospective analysis was conducted on data from the Fujian Maternity and Child Health Hospital. Pregnant women (n=214) who underwent cesarean section after receiving labor analgesia. We performed correlation heat map and Lasso regression in terms of exclusion confounding factors and screening independent variables. A nomogram was developed to predict the occurrence. Results The developed nomogram incorporated variables such as pregnant history, weight, premature rupture of membranes (PROM), dural puncture epidural (DPE), anesthesiologist level of cesarean section (ALOCS), and Anesthesiologist level of labor analgesia (ALOLA). The model demonstrated good predictive performance, providing a practical tool for assessing the risk of failure in converting labor analgesia to cesarean section anesthesia. Conclusion The nomogram can aid anesthesiologists in making informed decisions and optimizing patient care. By utilizing the nomogram, clinicians can estimate the probability of conversion failure based on individual patient characteristics and clinical factors.
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Affiliation(s)
- Yihan Zheng
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, People’s Republic of China
| | - Li Zhang
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, People’s Republic of China
| | - Xizhu Wu
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, People’s Republic of China
| | - Min Zhou
- Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian, People’s Republic of China
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Li P, Ma X, Han S, Kawagoe I, Ruetzler K, Lal A, Cao L, Duan R, Li J. Risk factors for failure of conversion from epidural labor analgesia to cesarean section anesthesia and general anesthesia incidence: an updated meta-analysis. J Matern Fetal Neonatal Med 2023; 36:2278020. [PMID: 37926901 DOI: 10.1080/14767058.2023.2278020] [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: 07/07/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia. METHODS We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ). RESULTS A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5-8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = -1.571, 95% CI: -1.116 to -0.975) and taller (WMD = 0.893, 95% CI: 0.018-1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight. CONCLUSION Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group.
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Affiliation(s)
- Pan Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoting Ma
- Department of Clinical Laboratory, Hebei General Hospital, Shijiazhuang, China
| | - Shuang Han
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - Amos Lal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Longlu Cao
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Ran Duan
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
| | - Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, China
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Chao WH, Cheng WS, Hu LM, Liao CC. Risk factors for epidural anesthesia blockade failure in cesarean section: a retrospective study. BMC Anesthesiol 2023; 23:338. [PMID: 37803290 PMCID: PMC10557188 DOI: 10.1186/s12871-023-02284-w] [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: 07/04/2023] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Epidural anesthesia (EA) is the regional anesthesia technique preferred over spinal anesthesia for pregnant women requiring cesarean section and post-operative pain control. EA failure requires additional sedation or conversion to general anesthesia (GA). This may be hazardous during sedation or GA conversion because of potentially difficult airways. Therefore, this retrospective study aimed to determine the risk factors for epidural failure during cesarean section anesthesia. METHODS We retrospectively analyzed parturients who underwent cesarean section under EA and catheterization at the Chang Gung Memorial Hospital in Taiwan between January 1 and December 31, 2018. Patient data were collected from the medical records. EA failure was defined as the administration of any intravenous anesthetic at any time during a cesarean section, converting it into GA. RESULTS A total of 534 parturients who underwent cesarean section were recruited for this study. Of them, 94 (17.6%) experienced EA failure during cesarean section. Compared to the patients with successful EA, those with EA failure were younger (33.0 years vs. 34.7 years), had received EA previously (60.6% vs. 37%), were parous (72.3% vs. 55%), and had a shorter waiting time (14.9 min vs. 16.5 min) (p < 0.05). Younger age (OR 0.91, 95% CI 0.86-0.95), history of epidural analgesia (OR 2.61, 95% CI 1.38-4.94), and shorter waiting time (OR 0.91, 95% CI 0.87-0.97) were estimated to be significantly associated with a higher risk of epidural anesthesia failure. CONCLUSION The retrospective study found that parturients of younger age, previous epidural catheterization history, and inadequate waiting time may have a higher risk of EA failure. Previous epidural catheterization increased the risk of EA failure by 2.6-fold compared to patient with no history of catheterization.
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Affiliation(s)
- Wei-Hsiang Chao
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Wen-Shan Cheng
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Li-Ming Hu
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan
| | - Chia-Chih Liao
- Department of Anesthesiology, Chang Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
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Jian Z, Longqing R, Dayuan W, Fei J, Bo L, Gang Z, Siying Z, Yan G. Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section. Ann Med 2022; 54:1112-1117. [PMID: 35443838 PMCID: PMC9891221 DOI: 10.1080/07853890.2022.2067353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion. METHODS Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarean delivery between May 2019 and April 2020 at the Chengdu Women's and Children's Central Hospital, Sichuan Maternal and Child Health Hospital, and Jinjiang District Maternal and Child Health Hospital were selected. If the position of the epidural catheter was correct and the effect was good, patients were converted to epidural surgical anaesthesia. If epidural labour analgesia was ineffective, spinal anaesthesia (SA) was administered immediately. For category-1 emergency caesarean sections, general anaesthesia (GA) was administered. RESULTS A total of 1084 parturients underwent conversion. Of these, 19 (1.9%) received GA due to the initiation of category-1 emergency caesarean section. 704 (64.9%) were converted to epidural surgical anaesthesia, 2 (0.2%) had failed conversions and were administered GA before delivery, and 357 (32.9%) were converted to SA. Logistic regression analysis showed that prolonged duration of epidural labour analgesia ([Crude odds ratio (OR)=1.065; 95% confidence interval (CI), 1.037-1.094; p < .01]; [Adjusted OR = 1.060; 95% CI, 1.031-1.091; p < .01]) was an independent risk factor for conversion failure. A receiver operating characteristic curve constructed using duration of epidural labour analgesia showed that parturients with a duration of epidural labour analgesia ≥8 h, more frequently required a change of anaesthesia technique during conversion, and the relative risk of conversion failure was 1.54 (95% CI, 1.23-1.93; p < .01). CONCLUSION Prolonged duration of epidural labour analgesia increases the possibility of having an invalid epidural catheter, resulting in an increased risk of conversion failure from epidural labour analgesia to epidural surgical anaesthesia. Further, this risk is higher when the time exceeds 8 h. KEY MESSAGESProlonged duration of epidural labour analgesia > 8 h is associated with conversion failure.If it is impossible to judge whether the conversion is successful immediately, spinal anaesthesia should be administered to minimise complications.
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Affiliation(s)
- Zhang Jian
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
| | - Ran Longqing
- Chengdu Women's and Children's Central Hospital (School of Medicine, University of Electronic Science and Technology of China), Chengdu
| | | | - Jia Fei
- Jinjiang Maternity and Child Health Hospital, Chengdu
| | - Liu Bo
- Jinjiang Maternity and Child Health Hospital, Chengdu
| | - Zhang Gang
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
| | - Zhu Siying
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
| | - Gao Yan
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
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Larijani SS, Niksolat M, Mirfakhraee H, Rahimi M, Asadi S, Mahdavynia S, Mousavi A, Larijani RS. Comparison of the outcomes of normal vaginal delivery with and without spinal anesthesia in mothers admitted to the maternity ward of Firoozabadi Hospital. J Family Med Prim Care 2022; 11:5633-5637. [PMID: 36505630 PMCID: PMC9731025 DOI: 10.4103/jfmpc.jfmpc_1998_21] [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: 10/06/2021] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction and Objective The study of the methods of controlling labor pain is very important. One of the methods of pain relief is spinal anesthesia. Due to the different opinions about the effects of spinal anesthesia on the delivery process and maternal and fetal consequences, this study aimed to evaluate the effects of spinal anesthesia and compare it with normal vaginal delivery without spinal anesthesia. Methods In this retrospective cohort study, 120 mothers, who were admitted to the maternity ward of Firoozabadi Hospital for delivery, were examined. The patients who met the inclusion criteria were divided into two groups of 60 people, one group receiving spinal anesthesia and one without spinal anesthesia, and then, were evaluated in terms of clinical variables and complications of the mother and fetus. Data were analyzed using SPSS statistical software. Results The mean age of the mothers was 26.6 ± 5.9 years. Five mothers (4.2%) who received spinal anesthesia underwent emergency cesarean section and a significant difference was shown between the two groups (P = 0.02). The mean duration of the active phase of labor did not show a statistically significant difference between the two groups (P = 0.2), but the duration of the second phase of labor was significantly longer in the mothers who received spinal anesthesia (P = 0.008). Conclusion Spinal anesthesia can be used as a low-complication method in vaginal delivery to reduce pain.
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Affiliation(s)
- Samaneh Saghafian Larijani
- Department of Obstetrics and Gynecology, Firoozabadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Niksolat
- Department of Geriatric, Firoozabadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Hosna Mirfakhraee
- Department of Internal Medicine, Firoozabadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahimi
- Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Tehran, Iran
| | - Shima Asadi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Mahdavynia
- Department of Pediatric Nephrology, Firoozabadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Ashraf Mousavi
- Department of Pediatrics, Firoozabadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Roshana Saghafian Larijani
- Department of Pharmaceutical Science, Tehran University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Roshana Saghafian Larijani, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran. E-mail:
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Shokrpour M, Reza PPS, Sharifi M, Kamali A. Prevalence of Cesarean Section and Analysis of Neonatal Apgar Score and the Mean Time of Second Phase of Labor in Pregnant Women. Med Arch 2020; 73:399-403. [PMID: 32082008 PMCID: PMC7007604 DOI: 10.5455/medarh.2019.73.399-403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: The labor pain is probably the most severe pain a mother experiences in her lifetime and is usually severe and prolonged in women with pregnancy, Aim: To evaluate the effects of labor epidural and spinal analgesia on the incidence of cesarean section in painless delivery. Methods: This randomized clinical trial was conducted on pregnant women aged 37-42 weeks of pregnancy. Female candidates for painless labor were divided into two groups: Epidural Analgesia (EA) and Spinal Analgesia (SA). Patients in the labor epidural group underwent analgesia using marcaine and fentanyl and after fully assuring the normal hemodynamic status of the mother and fetal hearth rate (FHR), labor spinal analgesia was used for other group. Results: The average age of mothers was 27.5 years, their mean gestational age was 39 weeks and their mean weight was determined to be 72 kg. Frequency of cesarean delivery in mothers was found as 12.9%. Significantly, the incidence of cesarean section in the labor epidural analgesia group was higher than the labor spinal analgesia group (P = 0.02). In addition, the mean second phase of delivery in the labor epidural analgesia group was significantly higher than the labor spinal analgesia group (P = 0.03). There was no significant in 1st and 5th min Apgar scores between groups in infants (8.6 and 9.6, respectively). Conclusion: Labor epidural analgesia and labor spinal analgesia result in a significant reduction in pain due to normal delivery. Due to the similarity of Apgar and arterial blood gas (ABG) in neonates, labor epidural analgesia may serve as an alternative in childbirth delivery.
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Affiliation(s)
- Maryam Shokrpour
- Department of Gynecology, Arak University of Medical Sciences, Arak, Iran
| | | | - Mehrzad Sharifi
- Department of Surgery, Arak University of Medical Sciences, Arak, Iran
| | - Alireza Kamali
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
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Shen C, Chen L, Yue C, Cheng J. Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study. J Matern Fetal Neonatal Med 2020; 35:1127-1133. [PMID: 32204637 DOI: 10.1080/14767058.2020.1743661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice.Methods: Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered via the epidural catheter. Case data were reviewed and analyzed of cesarean section anesthesia implementation methods, results and maternal and neonatal outcomes.Results: Of the 1254 parturient, 4.7% (59 of 1254) underwent general anesthesia directly, 7.1% (89 of 1254) were given combined spinal and epidural anesthesia, and the other 88.2% (1106 of 1254) underwent extending epidural anesthesia, 3.5% (39 of 1106) of them were given general anesthesia after extending epidural anesthesia failed, and 96.5% (1067 of 1106) parturient have a successful extending epidural anesthesia. Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8-10 points.Conclusion: Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section.
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Affiliation(s)
- Chan Shen
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuchang, China
| | - Lin Chen
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuchang, China
| | - Chengjin Yue
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuchang, China
| | - Jing Cheng
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Wuchang, China
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Ducloy-Bouthors AS, Fuzier V, Bensoussan H, Barre-Drouard C, Bourzoufi K, Richart P, Cottencin O, Bernard F. Accompagnement avec l’hypnose d’une césarienne programmée ou non programmée. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s11724-016-0454-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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