An Obstetric Anaesthetist a Key to Successful Conversion of Epidural Analgesia to Surgical Anaesthesia for Caesarean Delivery?

E.E Bjornestad,M.F Haney

doi:10.1097/01.aoa.0000744216.58176.cc

Abstract

(Acta Anaesthesiol Scand. 2020;64:142–144) A recent report by Wagner et al explores whether the presence of an obstetric anesthetist influences the mode of anesthesia in emergency cesarean delivery. General anesthesia used in cesarean delivery is associated with risks, while epidural anesthesia should only be used in cases when labor analgesia has been established. Using regional anesthesia to avoid general anesthesia in emergency cesarean deliveries may decrease the risk of hypoxia and unwanted intraoperative awareness, and may decrease postoperative pain. The Royal College of Anesthetists suggest an acceptable rate of less than 3% for general anesthesia in patients receiving labor epidural analgesia.

Highlights

Given widely recognized risks associated with general anaesthesia and urgent/emergent C‐section, how often can one safely manage the parturient with regional anaesthesia? Is this an expected result of subspecialty training, to more aggressively use regional anaesthesia in this setting? While spinal anaesthesia has gained wide acceptance, even with limited time frame goals from de‐ cision to delivery, epidural anaesthesia should be used when labour analgesia has been established prior to an emergency C‐Section
The use of general anaesthesia may be reduced if the anaesthesiologist attending the emergency C‐section is an obstetric anaesthetist as op‐ posed to a non‐specialist.[1]
Avoiding general anaesthesia or implementing regional an‐ aesthesia in emergency deliveries is presumed to decrease risk of unwanted intraoperative awareness, the risk of hypoxia related to general anaesthesia and with failed intubation or aspiration of gastric contents into the lung

Summary

Introduction

(2020) An obstetric anaesthetist: A key to successful conversion of epidural analgesia to surgical anaesthesia for caesarean delivery? An obstetric anaesthetist—A key to successful conversion of epidural analgesia to surgical anaesthesia for caesarean delivery?

Results

Conclusion