Neuraxial and general anaesthesia for caesarean section

Watson, Sarah E.; Richardson, Alexandra J.; Lucas, D. N.

doi:10.1016/j.bpa.2022.04.007

Cited by 24 publications

(10 citation statements)

References 64 publications

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“…22 Moreover, in the case of women experiencing pain under neuraxial anesthesia, converting to general anesthesia is acceptable, especially in prolonged surgeries. 23 This finding provides an explanation for the observed association between general anesthesia and prolonged CD time.…”

Section: Our Findings In the Context Of Other Observationsmentioning

confidence: 64%

“…General anesthesia is virtually exclusively used in emergency situations or when neuraxial anesthesia techniques have failed or are contraindicated 22 . Moreover, in the case of women experiencing pain under neuraxial anesthesia, converting to general anesthesia is acceptable, especially in prolonged surgeries 23 . This finding provides an explanation for the observed association between general anesthesia and prolonged CD time.…”

Section: Discussionmentioning

confidence: 99%

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The association between indications for cesarean delivery and surgery time

Gabbai,

Lavie,

Yogev

et al. 2023

Intl J Gynecology & Obste

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ObjectiveWe aimed to determine risk factors for prolonged surgery time of cesarean delivery (CD).MethodsWe conducted a retrospective cohort study in a single tertiary university–affiliated medical center (2011–2022). The study group consisted of all women who underwent CD that lasted >90 min (representing the 95th percentile of CD length in our cohort). Data were compared with CDs with an operation time of <90 min. Demographic, obstetric, and surgical characteristics, as well as indications for surgery and urgency (in labor vs. elective surgery), were compared.ResultsOverall, during the study period, 31 660 CDs were performed in our center. Of them, 1397 (4.4%) lasted >90 min.After applying a multivariate analysis, abnormal placentation (relative risk [RR] 1.5 [95% confidence interval (CI), 1.3–1.8]), previous uterine scar (RR, 2.15 [95% CI, 1.5–3.0]), general anesthesia (RR, 3.5 [95% CI, 2.9–4.4]) and preterm delivery (RR, 2.06 [95% CI, 1.78–2.4]) were found to be associated with prolonged surgical time. CD due to malpresentation (RR, 0.57 [95% CI, 0.46–0.7]), multiple gestations (RR, 0.72 [95% CI, 0.6–0.9]), and patient request (RR, 0.56 [95% CI, 0.38–0.84]) were found to be protective factors.ConclusionThe main risk factors associated with additional surgery time in CD are general anesthesia, abnormal placentation, previous uterine scar, and preterm delivery.

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Section: Our Findings In the Context Of Other Observationsmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

The association between indications for cesarean delivery and surgery time

Gabbai,

Lavie,

Yogev

et al. 2023

Intl J Gynecology & Obste

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“…Severe and occasionally life-threatening complications related to neuraxial anaesthesia (subdural hematoma [38], meningitis, permanent neurological damage, chemical arachnoiditis [39]) are so rare in the obstetric cohort that they are difficult to assess, with permanent neurologic complications estimated between 0.3 and 1.2 per 100.000 [40]. Because of its reliability and safety profile, neuraxial anaesthesia is considered the technique of choice in conducting elective CS [41], because it appears safer for the mother (not exposed to general anaesthesia-associated risks, mainly difficult airway management and pulmonary aspiration) and the newborn [42]. General anaesthesia is ultimately reserved when neuraxial anaesthesia is contraindicated or for Category 1 CS.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study

Zanfini,

Di Muro,

Biancone

et al. 2023

JCM

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ESP block (ESPB) and posterior Quadratus Lumborum Block (pQLB) have been proposed as opioid-sparing techniques for the management of pain after abdominal surgery. Between December 2021 and October 2022, we conducted a retrospective comparative study at the delivery suite of Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, to compare the efficacy of ESPB and pQLB in preventing postoperative pain after an elective caesarean section (CS). The primary outcome was total morphine consumption in the first 24 h. Secondary outcomes were time to first opioid request; Numerical Pain Rating Scale (NPRS) at 0, 2, 6, 12 and 24 h; vital signs; adverse events. Fifty-two women were included. The total cumulative dose of morphine was not significantly different between the two groups of patients (p = 0.897). Time to first dose of morphine, NPRS values and haemodynamic parameters were not statistically different between the two groups. NPRS values significantly increased (p < 0.001) at the different time intervals considered. The need for rescue doses of morphine was lower in the ESPB group compared to the pQLB group (hazard ratio of 0.51, 95% CI (0.27 to 0.95), p = 0.030). No adverse event was reported. ESPB seems to be as effective as pQLB in providing analgesia after CS.

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“…In cesarean sections, neuraxial anesthesia is preferred over general anesthesia; however, general anesthesia is still administered under some conditions [ 28 ]. Because pregnancy-related physiological changes peak at term and delivery, the efficacy and safety profiles are of primary concern when using sugammadex after fetus delivery.…”

Section: Clinical Evidencementioning

confidence: 99%

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

Cho

2023

Anesth Pain Med

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Sugammadex is a chemically modified γ-cyclodextrin that is used as a selective reversal agent for steroidal neuromuscular blockade. The use of sugammadex has greatly increased globally; however, little is known about its potential adverse effects in pregnant and lactating women or those using hormonal contraceptives. There are three important theoretical assumptions. Firstly, pregnancy-related physiological changes involve most organs and affect the pharmacokinetic profiles of medications. Considering the physiological changes in pregnant women and the pharmacokinetic properties of sugammadex, alterations in the dosage and safety profiles of sugammadex may occur during pregnancy. Secondly, very large and polarized sugammadex molecules are expected to have limited placental transfer to the fetus and excretion into breast milk. Finally, sugammadex can bind to steroidal neuromuscular blocking agents as well as other substances with similar structures, such as progesterone. As a result of using sugammadex, progesterone levels can be reduced, causing adverse effects such as early pregnancy cessation and failure of hormonal contraceptives. This narrative review aims to demonstrate the correlations between sugammadex and pregnancy, lactation, and reproductive potential based on previously published preclinical and clinical studies. This will bridge the gap between theoretical assumptions and currently unknown clinical facts. Moreover, this review highlights what anesthesia providers should be aware of and what actions to take while administering sugammadex to such patients.

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Neuraxial and general anaesthesia for caesarean section

Cited by 24 publications

References 64 publications

The association between indications for cesarean delivery and surgery time

The association between indications for cesarean delivery and surgery time

Ultrasound-Guided Bilateral Erector Spinae Plane Block vs. Ultrasound-Guided Bilateral Posterior Quadratus Lumborum Block for Postoperative Analgesia after Caesarean Section: An Observational Closed Mixed Cohort Study

What we need to know and do on sugammadex usage in pregnant and lactating women and those on hormonal contraceptives

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