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The impact of increasing the use of regional anaesthesia for emergency Caesarean section

Published online by Cambridge University Press:  28 January 2005

E. Bjørnestad ,
O. E. Iversen  and
J. Raeder
E. Bjørnestad
Affiliation:
Haukeland University Hospital, Department of Anaesthesiology and Intensive Care, Bergen, Norway
O. E. Iversen
Affiliation:
Haukeland University Hospital, Department of Obstetrics and Gynaecology, Bergen, Norway
J. Raeder
Affiliation:
Ulleval University Hospital, Department of Anaesthesiology, Oslo, Norway
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Extract

Summary

Background and objective: In 1991 general anaesthesia was used extensively for emergency Caesarean section at Haukeland University Hospital even in patients with an ongoing epidural infusion. With increased knowledge of the potential safety benefits of regional anaesthesia and increased experience with the technique, we decided to use indwelling epidural catheters for emergency Caesarean section.

Methods: We conducted a retrospective analysis of a full annual data set on emergency Caesarean section in parturients with ongoing epidural analgesia in 1997 and compared it with a similar data set from 1991.

Results: Epidural anaesthesia was used significantly more often in 1997 with 115 (78%) cases than in 1991 with five (12%) cases (P < 0.001). Elapsed time before adequate anaesthesia and the start of surgery was significantly shorter in 1991 (mean 8.3 min) compared to 1997 (mean 13 min) (P < 0.001). No deaths or major complications were observed in either group. Intraoperative minor complications were observed more frequently in 1997 with 70 cases (47%) than in 1991 with two cases (6%) (P < 0.001). The principal complications were hypotension and nausea. Postoperative complications in mother and neonate were similar in both groups. There was a significantly shorter mean hospital stay in 1997 (6 days), compared with 1991 (8 days) (P < 0.001).

Conclusion: The increase in the use of indwelling epidural catheters for emergency Caesarean section has resulted in a significant increase in the use of regional anaesthesia. A modest increase in time elapsed before start of surgery was observed although there were no significant differences in the number of neonates with low Apgar scores. No major complications were observed, but there was an increased frequency of minor complications in 1997.

Keywords

ANALGESIA, EPIDURAL, catheterANAESTHESIA, OBSTETRICALCAESAREAN SECTION, emergency
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 10 , October 2004 , pp. 776 - 780
Copyright
© 2004 European Society of Anaesthesiology

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References

Samsoon GL, Young JR. Difficult tracheal intubation. A retrospective study. Anaesthesia 1987; 42: 487–490.Google Scholar
Barnardo PD, Jenkins JG. Failed intubation in obstetrics: a 6-years review in a UK region. Anaesthesia 2000; 55: 690–694.Google Scholar
Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia related deaths during obstetric delivery in the United States 1979–1990. Anesthesiology 1997; 86: 277–284.Google Scholar
Hawthorne L, Wilson R, Lyons G, Dresner M. Failed intubation revisited: 17 year experience in a teaching maternity unit. Br J Anaesth 1996; 76: 680–684.Google Scholar
Hamer M. Difficult and failed intubation in obstetrics. Intern J Obstetric Anesth 1997; 6: 25–31.Google Scholar
Chestnut DH. Anesthesia and maternal mortality. Anesthesiology 1997; 86: 273–276.Google Scholar
Moir DD. Maternal mortality and anaesthesia. Br J Anaesth 1980; 52: 1–3.Google Scholar
Ratcliff FM, Evans JM. Neonatal wellbeing after elective Caesarean section with general, spinal and epidural anaesthesia. Eur J Anaesthesiol 1993; 10: 175–181.Google Scholar
Abboud TK, Nagappala S, Murakawa K, et al. Comparison of the effects of general and regional anaesthesia for caesarean section on neonatal neurologic and adaptive capacity scores. Anesth Analg 1985; 64: 996–1000.Google Scholar
Lucas-Bouwman ME, Koen MD, Brugge HG, Rutten CLG, Brand PLP. Sanaehang tussen indicatie voor sectio caesarea en noodznak van reanimatie van de neonatus. Ned Tijdschr Geneeskd 2000; 19: 897–900.Google Scholar
Morgan BM, Magni V, Goroszenuik T. Anaesthesia for emergency caesarean section. Br J Obstet Gynaecol 1990; 97: 420–424.Google Scholar
Hamza J. Soffrance foetale aigue. Point de vue de l'anesthesist. Cah-Anesthesiol 1996; 4: 309–326.Google Scholar
James D. Caesarean section for fetal distress. BMJ 2001; 322: 1316–1317.Google Scholar
Tuffnell DJ, Wilkinson K, Beredsford N. Interval between decision and delivery by caesarean section – are current standards achievable? BMJ 2001; 322: 1330–1333.Google Scholar
Gibbs D. Confidential enquiries into maternal death. Commentary. Br J Obstet Gynaecol 1990; 97: 97–101.Google Scholar
Robson SC, Boys RJ, Rodeck C, Morgan B. Maternal and fetal haemodynamic effect of spinal and extradural anaesthesia for elective Caesarean section. Br J Anaesth 1992; 68: 54–59.Google Scholar
Morgan B. Unexpectedly extensive conduction blocks in obstetric analgesia. Anaesthesia 1990; 2: 148–152.Google Scholar
Checketts MR, Wildsmith JAW. Accidental i.v. injection of local anaesthesia: an avoidable event? Br J Anaesth 1998; 80: 710–711.Google Scholar