G Raghavan, N Siddiqui, W Whittle, K Downey, X Y Ye, J C A Carvalho
{"title":"紧急或急诊剖宫产全身麻醉的麻醉和产科预测因素:一项回顾性病例对照研究。","authors":"G Raghavan, N Siddiqui, W Whittle, K Downey, X Y Ye, J C A Carvalho","doi":"10.1007/s00540-024-03411-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates.</p><p><strong>Methods: </strong>This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes.</p><p><strong>Results: </strong>Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to \"limited time due to maternal/fetal compromise\" (56%), followed by \"maternal contraindication to RA\" (25%) and \"inadequate RA\" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)).</p><p><strong>Conclusion: </strong>Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.</p>","PeriodicalId":14997,"journal":{"name":"Journal of Anesthesia","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.\",\"authors\":\"G Raghavan, N Siddiqui, W Whittle, K Downey, X Y Ye, J C A Carvalho\",\"doi\":\"10.1007/s00540-024-03411-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates.</p><p><strong>Methods: </strong>This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes.</p><p><strong>Results: </strong>Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to \\\"limited time due to maternal/fetal compromise\\\" (56%), followed by \\\"maternal contraindication to RA\\\" (25%) and \\\"inadequate RA\\\" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)).</p><p><strong>Conclusion: </strong>Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.</p>\",\"PeriodicalId\":14997,\"journal\":{\"name\":\"Journal of Anesthesia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00540-024-03411-8\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00540-024-03411-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:在剖宫产(CD)中,区域麻醉(RA)被认为优于全身麻醉(GA),但在某些情况下仍有必要使用全身麻醉。本研究回顾了剖宫产使用 GA 的实践模式,以确定可改变 GA 的预测因素,从而降低 GA 发生率:这是一项回顾性病例对照研究。方法:这是一项回顾性病例对照研究,研究人员确定了 3 年内接受急诊/紧急 CD 治疗的患者,并从中随机抽取了 102 名接受 GA 治疗的患者和 102 名接受 RA 治疗的患者。数据包括患者特征、CD的产科指征、麻醉类型/指征、气道管理(GA组)/经鼻麻醉(RA组)的特征以及新生儿结局:在病例组(39%)和对照组(39%)中,胎心率异常(aFHR)是最常见的产科急诊/紧急剖宫产指征。使用 GA 的最常见原因是 "由于母体/胎儿受损导致时间有限"(56%),其次是 "母体禁忌 RA"(25%)和 "RA 不充分"(17%)。GA最常见的可修改麻醉指征是神经轴麻醉不足(17%)。GA的麻醉和产科预测因素包括ASA分类[OR 0.11 (0.06-0.21)]、紧急代码启动[OR 13.55 (1.73-106.40)]、产程进展失败[OR 0.15 ((0.06-0.OR0.16(0.05-0.57)]、妊娠相关疾病[OR8.63(1.06-70.38)]、脐带/胎儿脱垂[14.85(1.90-115.94)]和胎龄(OR0.86(0.81-0.92)):结论:胎儿心率异常,尤其是心动过缓,是产科急诊/紧急 CD 最常见的 GA 适应症,而神经麻醉不足则是最易改变的麻醉适应症。我们的数据表明,胎心率异常和脐带/胎儿脱垂是在某些情况下发生GA的潜在风险因素。
Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.
Purpose: While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates.
Methods: This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes.
Results: Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)).
Conclusion: Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.
期刊介绍:
The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite.
The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.