192 Neonatal outcomes with prolonged anesthesia to delivery time

Abstract

Cesarean delivery (CD) is one of the most common surgical procedures. Recent studies found no difference in neonatal outcomes with general anesthesia (GA) vs. regional anesthesia (RA). Yet, the effects of a prolonged start of anesthesia to delivery time (ADT) remain unknown. We hypothesized that prolonged ADT does not alter the neonatal outcomes. We reviewed all complicated obstetric deliveries from 7/1/15 to 8/10/20 with ADT >10 minutes (m). Cases with fetal anomalies, twin gestations, emergent CD, and patients in active labor were excluded. Maternal demographics, operative details including ADT and uterine incision to delivery time (UDT), gestational age at delivery (GD), Apgar scores at 1 and 5m, arterial cord blood pH (ApH), and cord blood gasses were compared between GA and RA groups using the Mann-Whitney U test and the χ2, as appropriate. Logistic regression analysis was used to identify the predictors of Apgar score <7 at 5m and ApH<7.2. Out of 258 cases, 61 were done under GA and 197 under RA. There was no difference in the time ADT or UDT (41m [10-82] vs. 44m [15-82], p=1.6 and 2m [0-6] vs. 2m [0-12], p=0.43 accordingly). Maternal demographics, comorbidities, and pregnancy complications are reported in Table 1.1. GD was lower in the GA group, 34.8 (26.6-39.1) vs. RA group, 37 (27.1-40.4), p<.001. There was no difference in the median ApH (7.24 [7.12-7.35] vs. 7.23 [7-7.39], p=.178) or in the ApH <7.2 (10 [16.4%] vs. 47 [23.9%], p=0.21). Cord blood gasses were not clinically different (Table 1.2). Apgar score <7 at 5m were different between groups (23 [37.7%] vs. 11 [5.6%], p<0.001). However, in the logistic regression, the type of anesthesia, ADT, and UDT did not alter the Apgar score at 5 minutes (Table 2.1) or the ApH (p>0.05) (Table 2.2). Favorable neonatal outcomes are seen with both GA and RA. Even with prolonged ADT (median 41m), there were no differences in ApH<7.2 and Apgar scores <7 at 5 min. Nevertheless, further research is required to evaluate long-term outcomes with prolonged ADT.View Large Image Figure ViewerDownload Hi-res image Download (PPT)