¿Es realmente necesaria y útil la oxigenoterapia suplementaria en la cesárea programada bajo anestesia subaracnoidea?

Palacio, F.J.; Ortiz-Gómez, J.R.; Fornet, I.; Morillas, Pedro; Bermejo, L.; López, Á.

doi:10.1016/s0034-9356(08)70670-4

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…Ten trials were performed in patients undergoing scheduled CD with regional anesthesia and 4 trials were performed in women in labor . One trial included both scheduled CD and emergent CD during labor, and another trial only included patients undergoing emergency CD during labor.…”

Section: Resultsmentioning

confidence: 99%

“…Only 1 trial had loss to follow-up greater than 15% . Four trials did not perform or specifically report an intention-to-treat analysis …”

Section: Resultsmentioning

confidence: 99%

“…Fourteen trials reported results for UA pH—the primary outcome of this review . One of these trials had a cohort of patients randomized at the time of the scheduled CD and another cohort randomized at the time of an emergent CD during labor.…”

Section: Resultsmentioning

confidence: 99%

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Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation

et al. 2021

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IMPORTANCE Supplemental oxygen is commonly administered to pregnant women at the time of delivery to prevent fetal hypoxia and acidemia. There is mixed evidence on the utility of this practice.OBJECTIVE To compare the association of peripartum maternal oxygen administration with room air on umbilical artery (UA) gas measures and neonatal outcomes.DATA SOURCES Ovid MEDLINE, Embase, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from February 18 to April 3, 2020. Search terms included labor or obstetric delivery and oxygen therapy and fetal blood or blood gas or acid-base imbalance.STUDY SELECTION Studies were included if they were randomized clinical trials comparing oxygen with room air at the time of scheduled cesarean delivery or labor in patients with singleton, nonanomalous pregnancies. Studies that did not collect paired umbilical cord gas samples or did not report either UA pH or UA PaO 2 results were excluded.DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers. The analysis was stratified by the presence or absence of labor at the time of randomization. Data were pooled using random-effects models. MAIN OUTCOMES AND MEASURESThe primary outcome for this review was UA pH. Secondary outcomes included UA pH less than 7.2, UA PaO 2 , UA base excess, 1-and 5-minute Apgar scores, and neonatal intensive care unit admission. RESULTSThe meta-analysis included 16 randomized clinical trials (n = 1078 oxygen group and n = 974 room air group). There was significant heterogeneity among the studies (I 2 = 49.88%; P = .03). Overall, oxygen administration was associated with no significant difference in UA pH (weighted mean difference, 0.00; 95% CI, −0.01 to 0.01). Oxygen use was associated with an increase in UA PaO 2 (weighted mean difference, 2.57 mm Hg; 95% CI, 0.80-4.34 mm Hg) but no significant difference in UA base excess, UA pH less than 7.2, Apgar scores, or neonatal intensive care unit admissions. Umbilical artery pH values remained similar between groups after accounting for the risk of bias, type of oxygen delivery device, and fraction of inspired oxygen. After stratifying by the presence or absence of labor, oxygen administration in women undergoing scheduled cesarean delivery was associated with increased UA PaO 2 (weighted mean difference, 2.12 mm Hg; 95% CI, 0.09-4.15 mm Hg) and a reduction in the incidence of UA pH less than 7.2 (relative risk, 0.63; 95% CI, 0.43-0.90), but these changes were not noted among those in labor (PaO 2 : weighted mean difference, 3.60 mm Hg; 95% CI, −0.30 to 7.49 mm Hg; UA pH<7.2: relative risk, 1.34; 95% CI, 0.58-3.11).CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis suggests that studies to date showed no association between maternal oxygen and a clinically relevant improvement in UA pH or other neonatal outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Only 1 trial had loss to follow-up greater than 15% . Four trials did not perform or specifically report an intention-to-treat analysis …”

Section: Resultsmentioning

confidence: 99%

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Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation

et al. 2021

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“…Our study demonstrates that the routine administration of supplemental, low-dose oxygen via a nasal cannula during elective cesarean section under spinal anesthesia has potential benefit in terms of a decreased incidence of maternal desaturation. Maternal desaturation definitions have varied from <95% to <90% [11–13], and it has also been defined as a decrease of oxygen saturation of more than 4 percentage points from baseline [14]. We defined maternal desaturation according to the recommendation of O'Driscoll et al [7] and Van de Louw et al, [9] which was an oxygen saturation of <94% and the event occurring more than 30 seconds after probe checking.…”

Section: Discussionmentioning

confidence: 99%

Effects of Supplemental Oxygen on Maternal and Neonatal Oxygenation in Elective Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Siriussawakul

Triyasunant

Nimmannit

et al. 2014

BioMed Research International

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The use of supplemental oxygen in uncomplicated cesarean deliveries under spinal anesthesia has been thoroughly investigated during recent decades. The aim of this study was to determine the benefits for both mother and infant of administering supplemental, low-dose oxygen via a nasal cannula versus having no supplement (i.e., room air only). Healthy parturients at term undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups: an oxygen group (n = 170), who received 3 LPM oxygen via a nasal cannula; and a room-air group (n = 170), who were assigned to breathe room air. Maternal oxygen saturation was measured continuously by using pulse oximeter. The desaturation was determined by oxygen saturation <94% over 30 seconds. Umbilical cord gases and Apgar scores were collected followed delivery of the infant. All maternal desaturation events occurred in 12 parturients assigned to the room-air group. Most events were concurrent with hypotension. The umbilical venous partial pressure of oxygen was significantly higher in the oxygen group. The other blood gas measurements and Apgar scores were not significantly different between the two groups. Based on our findings, the use of supplemental oxygen could prevent maternal desaturation resulting from receiving sedation and intraoperative hypotension.

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“…They were divided into two groups (no oxygen supplement or oxygen FIO 2 40%). No difference in neonatal wellbeing was found [16].…”

Section: Discussionmentioning

confidence: 82%

Supplemental Perioperative Oxygen (80% FIO₂) for the Prevention of Surgical Site Infection after Emergency Cesarean Section

Admadé

Reyes

2013

ISRN Infectious Diseases

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Objective. Cesarean section can be a lifesaving procedure. However, as with many surgeries, it is not exempt of complications. Surgical site infections generate higher costs, serious morbidity, and mortality. This study evaluates the benefits of perioperative oxygen to prevent surgical site infections. Methods. We conducted a randomized controlled trial to assess the effects of perioperative oxygen to prevent surgical site infection after emergency cesarean section. Patients were randomized to receive either oxygen (80% FIO 2 ) during cesarean section plus two hours postsurgery or no supplemental oxygen. A sample of 326 patients was calculated for the primary outcome (163 in each group) and they were evaluated daily before leaving the hospital, at days 15 and 30. Results. Initially, 360 patients were enrolled, from which 17 were excluded (sample size: 343 (179 patients in the air group and 164 in the oxygen group)). We found no significant difference in the incidence of surgical site infection between these two groups at any of the evaluation times. Conclusion. In this study of patients with emergency cesarean section, we showed that the use of supplemental oxygen does not reduce the incidence of surgical site infection. This trial is registeres with ClinicalTrials.gov NCT01340534.

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¿Es realmente necesaria y útil la oxigenoterapia suplementaria en la cesárea programada bajo anestesia subaracnoidea?

Cited by 7 publications

References 26 publications

Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation

Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation

Effects of Supplemental Oxygen on Maternal and Neonatal Oxygenation in Elective Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Supplemental Perioperative Oxygen (80% FIO₂) for the Prevention of Surgical Site Infection after Emergency Cesarean Section

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¿Es realmente necesaria y útil la oxigenoterapia suplementaria en la cesárea programada bajo anestesia subaracnoidea?

Cited by 7 publications

References 26 publications

Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation

Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation

Effects of Supplemental Oxygen on Maternal and Neonatal Oxygenation in Elective Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Supplemental Perioperative Oxygen (80% FIO2) for the Prevention of Surgical Site Infection after Emergency Cesarean Section

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Supplemental Perioperative Oxygen (80% FIO₂) for the Prevention of Surgical Site Infection after Emergency Cesarean Section