Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study.
caesarean section
conversion
general anaesthesia
spinal anaesthesia
Journal
Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Titre abrégé: Acta Anaesthesiol Scand
Pays: England
ID NLM: 0370270
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
14
08
2022
received:
11
04
2022
accepted:
23
08
2022
pubmed:
4
9
2022
medline:
24
12
2022
entrez:
3
9
2022
Statut:
ppublish
Résumé
Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors. All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10-13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation. There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p < 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p < 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis. A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used.
Sections du résumé
BACKGROUND
Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors.
METHODS
All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10-13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation.
RESULTS
There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p < 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p < 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis.
CONCLUSIONS
A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used.
Substances chimiques
Anesthetics, Local
0
Bupivacaine
Y8335394RO
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
29-35Informations de copyright
© 2022 Acta Anaesthesiologica Scandinavica Foundation.
Références
Landon M, Galan H, Jauniaux E. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2020.
Hamilton B, Martin J. 2021, Births: Provisional Data for 2020. National Center for Health Statistics. https://stacks.cdc.gov/view/cdc/104993
Bamber JH, Lucas DN, Plaat F, Russell R. Obstetric anaesthetic practice in the UK: a descriptive analysis of the National Obstetric Anaesthetic Database 2009-14. Br J Anaesth. 2020;125:580-587.
Keltz A, Heesen P, Katz D, et al. Intraoperative pain during caesarean delivery: incidence, risk factors and physician perception. Eur J Pain. 2021;26:219-226.
Fuzier R, Baraille B, Fuzier V, et al. Spinal anesthesia failure after local anesthetic injection into cerebrospinal fluid: a multicenter prospective analysis of its incidence and related risk factors in 1214 patients. Reg Anesth Pain Med. 2011;36:322-326.
Adesope OA, Einhorn LM, Olufolabi AJ, Cooter M, Habib AS. The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery. Int J Obstet Anesth. 2016;26:8-14. doi:10.1016/j.ijoa.2016.01.007
Garry M, Davies S. Failure of regional blockade for caesarean section. Int J Obstet Anesth. 2002;11(1):9-12. doi:10.1054/ijoa.2001.0903
Stanford SER, Bogod DG. Failure of communication: a patient's story. Int J Obstet Anesth. 2016;28:70-75.
Lopez U, Meyer M, Loures V, et al. Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study. Health Qual Life Outcomes. 2017;15:118.
Heesen P, Orbach-Zinger S, Grigoriadis S, Halpern S, Eidelman LA. The effect of analgesia and anesthesia on postpartum depression. Adv Anesth. 2020;38:157-165.
McCombe K, Bogod DG. Learning from the law. A review of 21 years of litigation for nerve injury following central neuraxial blockade in obstetrics. Anaesthesia. 2020;75:541-548.
Maronge L, Bogod D. Complications in obstetric anaesthesia. Anaesthesia. 2018;73(Suppl 1):61-66.
Parikh K, Seetharamaiah S. Approach to failed spinal anaesthesia for caesarean section. Indian J Anaesth. 2018;62:691-697.
Baghirzada L, Archer D, Walker A, Balki M. Anesthesia-related adverse events in obstetric patients: a population-based study in Canada. Can J Anaesth. 2021;69:72-85.
Yüksek A, Miniksar ÖH, Öz H. Incidence and causes of failed spinal anesthesia. Dubai Med J. 2020;3:50-54.
Ashagrie SE, Ahmed SA, Melesse DY. The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: a prospective observational study. Int J Surg. 2020;24:47-51.
Orbach-Zinger S, Grant TG, Zahalka M, et al. A national Israeli survey of neuraxial anesthesia for cesarean delivery: pre-operative block assessment and intra-operative pain management. Int J Obstet Anesth. 2022;50:103255.
Keita H, Deruelle P, Bouvet L, et al. Raising awareness to prevent, recognise and manage acute pain during caesarean delivery: the French Practice Bulletin. Anaesth Crit Care Pain Med. 2021;40:100934.
Guasch E, Brogly N, Mercier JM, et al. European minimum standards for obstetric analgesia and anaesthesia departments: an experts'consensus. Eur J Anaesthesiol. 2020;37:1115-1125.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61:344-349.
Core Team R. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2021.
Ginosar Y, Mirikatani E, Drover DR, Cohen SE, Riley ET. ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. Anesthesiology. 2004;100:676-682.
Weiniger CF, Heesen M, Knigin D, Deutsch F, Hilber N, Avidan A. Association between hyperbaric bupivacaine dose and maternal hypotension: retrospective database study of 8226 women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2021;133:967-975.
Kinsella SM, Carvalho B, Dyer RA, et al. Consensus statement collaborators. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73:71-92.
Onwochei DN, Ngan Kee WD, Fung L, Downey K, Ye XY, Carvalho JCA. Norepinephrine intermittent intravenous boluses to prevent hypotension during spinal anesthesia for cesarean delivery: a sequential allocation dose-finding study. Anesth Analg. 2017;125(1):212-218.
Xiao F, Drzymalski D, Liu L, Zhang Y, Wang L, Chen X. Comparison of the ED50 and ED95 of intrathecal bupivacaine in parturients undergoing cesarean delivery with or without prophylactic phenylephrine infusion: a prospective, double-blind study. Reg Anesth Pain Med. 2018;43:885-889.
Warren MH, Kamania J, Dennis AT. Immediate birth: an analysis of women and their babies undergoing time critical birth in a tertiary referral obstetric hospital. Int J Obstet Anesth. 2018;33:46-52.
Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004;13:227-233.
Obstetric Anaesthetist's Association. Pain Relief in Labor.
Orbach-Zinger S, Ginosar Y, Elliston J, et al. Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing caesarean delivery. Br J Anaesth. 2012;109:943-949.
Cheng CY, Chou YH, Chang CH, Liou SR. Trends of perinatal stress, anxiety, and depression and their prediction on postpartum depression. Int J Res Public Health. 2021;18:9307.
Hartmann S, Eilertsen EM, Ystrom E, Belsky J, Gjerde LC. Does prenatal stress amplify effects of postnatal maternal depressive and anxiety symptoms on child behaviour. Dev Psychol. 2020;1:128-137.
Kaydirak M, Yilmaz B, Demir A, Ümran O. The relationship between prenatal attachment, maternal anxiety, and postpartum depression: A longitudinal study. Perspect Psychiatr Care. 2022:58(2):715-723.
Senel CA, Mergan F. Premedication with midazolam prior to caesarean section has no neonatal adverse effects. Braz J Anesthesiol. 2014;64:16-21.
Miremberg H, Yirmiya K, Vinter D, et al. An informative video before planned caesarean-delivery and maternal anxiety: a multicenter randomized controlled trial. Am J Obstet Gynecol. 2022;4(3):100604.