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• W1994653806 abstract "S260 INTRODUCTION: There is considerable evidence demonstrating that neither regional nor general anesthesia will cause harm to the fetus if the anesthetics are administered properly, however maternal morbidity and mortality for cesarean section (CS) under general anesthesia (GA) is considerably higher than with regional anesthesia (RA). Despite the potential benefit of RA, many obstetricians and anesthesiologist hesitate to undertake a RA for an emergent C/S because of concern about an inadequate block, or delay in onset of induction of anesthesia as compared to a GA. Indeed some studies show that a RA can slightly delay the start of a C/S. No study has examined fetal and maternal outcome when a RA is attempted and then converted to GA because of a failed or inadequate block. This study was undertaken to determine whether the additional time taken for induction of RA and subsequent conversion to GA because of failed or inadequacy of block, adversely affects neonatal or maternal outcome, as compared to cases where the initial anesthetic choice was GA. METHODS: Parturients who underwent emergency cesarean section under GA between 12/1996-12/1997 were identified from a prospectively collected computerized obstetric anesthesia data bank. Data were extracted regarding maternal age, weight, ASA status, gestational age, indication for C/S, indication for GA, Apgar scores, cord blood gases, neonatal birth weight, OR entry /anesthesia start times, delivery times, and uterine incision to delivery times. Since in most clinical situations the anesthesia start times begins once the patient enters the operating room (OR), we calculated OR entry/anesthesia start to delivery times. The data obtained was divided into two groups: A= patients who received GA, B= patients who initially received RA which was subsequently converted to GA. Chi-square analysis and the Mann Whitney U test were used to compare the groups. RESULTS: A total of 661 C/S were performed, 68 of which received GA (10.14%). Of these 68, 35 had GA without failed RA and 33 patients had GA after failed regional. The rate of RA's subsequently converting to GA was 5.27%. There was no significant difference between the two groups with regards to patient age, weight, gestational age, and uterine incision to delivery times, Apgar scores at 1 and 5 minutes, cord blood gases, or indications for C/S despite the longer anesthesia start to delivery time in group B. Indications for emergency C/S did not differ between groups and were fetal distress (46%), malpresentation (13%), abruptio placenta (6%), failure to progress (3%), placenta previa (6%), and other (26%). (Table 1)Table 1CONCLUSION: Our data support the use of regional anesthetic as a first choice for emergent C/S when the patient is hemodynamically stable, and without coagulopathy, since it provides for a safer anesthetic which puts the mother at less risk for morbidity and mortality. This study also suggests that despite the additional time often required for regional anesthesia induction, even in the face of a failed regional which is subsequently converted to GA, neonatal outcome is not significantly affected." @default.
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• W1994653806 date "1999-02-01" @default.
• W1994653806 modified "2023-09-27" @default.
• W1994653806 title "REGIONAL ANESTHESIA SHOULD BE THE FIRST CHOICE OF ANESTHESIA IN EMERGENT CESAREAN SECTIONS WHENEVER POSSIBLE" @default.
• W1994653806 doi "https://doi.org/10.1097/00000539-199902001-00259" @default.
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