General Anaesthesia For Caesarean Section Research Articles

Anesthesia Management on 29 Weeks Pregnant Women with Intracranial SOL, Invasive Carcinoma Mammae and Bronchopneumoniaes

Background: Pregnancy gives whole different challenge for anesthesiologist because of we handle two lives at once. Brain tumor in pregnancy correlated with maternal mortality, prematurity and intra uterine growth restriction (IUGR). It makes delivery time, what kind of anesthesia technique we used choosen by the situation.Case: We report a case of anesthesia technique using general anesthesia (GA) to accommodate sectio cesarean transperitoneal profunda (SCTP) in a 29 weeks pregnancy age, G1P0A0 female patient, ASA IIIE with intracranial SOL suspect cerebri abscess multiple dd/ tuberculoma, invasive mammae carcinoma, and bronchopneumoniae.Disscussion: Space occupied lesion (SOL) is a lesion in intracranial space especially give effect to brain. In our patient with SOL from cerebri abscess multiple dd/ tuberculoma. It caused intracranial pressure increase and also spastic hemiparese dextra. Pregnancy termination was done depends on 29 weeks pregnancy with SOL in this patient. We used GA for cesarean section (CS). Anesthesia technique will be considered successful if new born baby activity, pulse, grimace, appearance, and respiration (APGAR) is good.Conclusion: Female G1P0A0, 32 years old, 29 weeks pregnancy age, single intrauterine fetus with intracranial SOL suspect cerebri abscess multiple dd/ tuberculoma, invasive mammae carcinoma, and bronchopneumoniae was consulted by Obstetrician to Anestesiologist to do CS with GA. During anesthesia and surgery, there was no complication. In this case, termination was done for baby and mother’s well being.

General anesthesia for cesarean section in a pregnant woman with systemic vascular malformation: a case report

BackgroundVascular malformations are composed of morphologically abnormal vascular tissue, and when located in the head and neck region, they can make it difficult to secure the airway during general anesthesia.Case presentationA 28-year-old pregnant woman with vascular malformations in the pharynx was scheduled to undergo a cesarean section, for which spinal anesthesia was initially chosen. However, after magnetic resonance imaging results revealed the presence of multiple vascular malformations in the lumbar multifidus muscles, spinal anesthesia was considered to be of high risk. Thus, the patient was subjected to general anesthesia tracheal intubation under sedation, and the course of the surgery was without complications.ConclusionsBecause the pathophysiology and clinical sequelae of vascular malformations may be involved in complications, thorough presurgical evaluation of the patient’s physical condition and careful anesthesia planning should be done.

Anesthesia management of superobese pregnant patient under spinal anesthesia in cesarean section

Morbidly obese parturient requires specialized anesthetic care for safe labour and delivery. Regional anesthesia is considered safer than general anesthesia for cesarean section in super morbid obese parturient. We present this case to discuss anesthetic challenges associated with regional anesthesia and our approach in successful management of cesarean section in super morbid obese parturient.

Patient Satisfaction With General Anesthesia Compared to Spinal Anesthesia for Cesarean Section: A Multicenter Observational Study.

Background Satisfaction in patients undergoing cesarean section (CS) is of great importance in every hospital. There are big differences between spinal and general anesthesia for CS in terms of outcome, recovery times, and quality of service. Methods This multicenter observational study included 1443 patients who had elective (n=622) or emergency (n=821) CS in five medical centers over the period of 16 months. Bauer questionnaire was used for measuring patient satisfaction after CS. The questionnaire contained 15 questions about anesthesia-related discomfort and satisfaction with anesthesia care. Results During the study period, 1161 (80%) patients underwent CS under general anesthesia (GA) and 282 of them (20%) received spinal anesthesia (SA) for CS. The most frequently reported anesthesia-related discomfort was pain at the surgical site (>70%), drowsiness (68%), and thirst (60%). The data on patient satisfaction showed high satisfaction that exceeded 90%. Anesthesia side effects were less frequent and the general satisfaction rate was higher in the SA group compared to the GA group (P < .001). Conclusion SA for CS had less frequent side effects and a better satisfaction rate compared to GA for CS. Hospitals need to make room for improvement of postoperative acute pain control and introduction to Enhanced Recovery After Surgery (ERAS) protocols for elective CS.

Managemen Anestesi untuk Seksio Sesarea dengan Strok Maternal Hemoragik

Stroke is the third leading cause of morbidity and mortality in many developed countries. Cerebrovascular disease during pregnancy can result from three main mechanisms—bleeding, arterial infarction, and venous thrombosis. Maternal stroke can be either ischemic or hemorrhagic. Ischemic stroke is a common stroke caused by loss of blood supply to an area of the brain. Hemorrhagic stroke is caused by bleeding into the brain due to rupture of a blood vessel. Cesarean section or neurosurgical intervention should be prioritized or performed simultaneously is an important issue, as is the decision to use general anesthesia or spinal and epidural when a cesarean section is performed. The anesthesia technique used should be made taking into account the overall maternal risk. Hyperventilation to reduce intracranial pressure (ICP) should be kept in the range of 25-30 mmHg because the normal range of PaCO2 during pregnancy decreases to 30-32 mmHg due to increased ventilation and progesterone. The use of mannitol to control ICP, there are associated risks of fetal dehydration; While other reports show that 0.2 to 0.5mg/kg of mannitol has no significant effect on fetal fluid balance. Special consideration is needed for women with preeclampsia. General anesthesia for cesarean section is associated with an increased risk of stroke when compared to neuraxial anesthesia in preeclampsic women. Regardless of maternal preeclampic status, maintenance of adequate oxygenation and hemodynamic stability is important for maternal and fetal safety.

General Anesthesia for Cesarean Section: Indications and Materno-Fetal Outcomes

Introduction: General Anesthesia (GA) during Cesarean Sections (CS) is uncommon. The objective of the study is to evaluate the maternal fetal outcome aiming to improve the care of the mother and the newborn.

Elective Cesarean Section under General Anesthesia Experience in more than 5,000 Patients at Melinda Women Hospital Bandung-Indonesia

BACKGROUND: Despite the safe nature of the procedure, cesarean section (CS) is still associated with higher maternal mortality and morbidity rates. CS can be performed under spinal, epidural, combined spinal and epidural, or general anesthesia. The choice of anesthesia for CS is still a matter of debate due to its side effects on mothers and neonates. Success in the selection of anesthesia in CS is seen in maternal and neonatal outcomes, where the Apgar score is used for assessing neonates in the first and fifth minutes. AIM: This study aimed to determine the effect of general anesthesia in cesarean section as measured by Apgar score. SUBJECT AND METHODS: This was a cross-sectional analytical retrospective study on a total sample of 7,131 patients who underwent elective cesarean section under general anesthesia during 18 years (July 2004–June 2022) at Melinda Women Hospital Bandung Indonesia. In this study, data from medical records were used to analyze neonatal and maternal outcomes. RESULTS: Of the 7,131 CS under general anesthesia cases, no maternal death or difficult ventilation was found; however, the incidence of postoperative nausea and vomiting (PONV) (15), difficult intubation (6), hypotension (5), and need for blood transfusion (5), and postoperative analgesia (all cases) were observed in the mothers. In neonates, neonatal death caused by IUFD and severe congenital disease (3), and a mean neonatal Apgar score of 9 and 10 at 1 and 5 min were identified. CONCLUSION: No low Apgar score is found as the effect of general anesthesia in cesarean section.

Ultrasonographic images of spina bifida before obstetric anesthesia: a case series

BackgroundSpina bifida is a relatively common congenital malformation. As the functional prognosis of patients with spina bifida has improved over time, the number of cases resulting in pregnancy and delivery has increased. Lumbar ultrasonography has become a standard and helpful technique before neuraxial anesthesia. We believe that it might be valuable if we use lumbar ultrasonography to evaluate pregnant women with spina bifida before obstetric anesthesia.Case presentationWe performed lumbar ultrasonography to evaluate four pregnant women with spina bifida. Patient 1 had no history of surgery. Lumbar radiography before pregnancy showed a bone defect from L5 to the sacrum as a result of incomplete fusion. Magnetic resonance imaging showed a spinal lipoma and a bone defect of the sacrum. Lumbar ultrasonography showed similar findings. We performed general anesthesia for emergency cesarean delivery. Patient 2 underwent surgical repair immediately after birth. Lumbar ultrasonography showed the same bone defect as well as a lipoma beyond the bone defect. We performed general anesthesia for cesarean delivery. Patient 3 had vesicorectal disorders but no prior surgery. Lumbar radiography before pregnancy showed congenital abnormalities such as incomplete fusion, scoliosis, rotation, and a notably small sacrum. Lumbar ultrasonography showed the same bone defect. We performed general anesthesia for cesarean section with no complications. Patient 4 complained of lumbago a few years after her first delivery and received a diagnosis of spina bifida occulta by lumbar radiography, with the incomplete fusion of only the 5th vertebra. Lumbar ultrasonography indicated the same abnormalities. We placed an epidural catheter to avoid the bone abnormality and achieved epidural labor analgesia with no complications.ConclusionsLumbar ultrasonography shows anatomic structures easily, safely, and consistently, without X-ray exposure or the need for more expensive modalities. It is a helpful technique to explore anatomic structures potentially complicated by spina bifida before anesthetic procedures.

Accidental Awareness Under General Anesthesia During Cesarean Section: An Observational Study.

Background A Caesarean section (CS) if performed under general anesthesia (GA) is a procedure with an increased risk of accidental awareness. This study aimed to examine the incidence of accidental awareness under GA in hospitals in the Republic of Srpska (Bosnia and Herzegovina) where GA for CS is performed in a significantly higher percentage compared to spinal anesthesia. Methodology In the period from 2016 to 2018, a multicenter, prospective, observational study was conducted in five medical centers in the Republic of Srpska (Bosnia and Herzegovina). The study included 1,161 patients who underwent CS. A total of 427 (36.7%) patients had elective and734 (63.3%) had emergency CSs. The patients were surveyed postoperatively using the modified Brice questionnaire. Results Of the 1,161 patients included in the study, 12 (1.03%) reported memory in the period between induction and emergence of anesthesia. Five (0.43%) of them reported definite and seven (0.6%) possible and unlikely awareness. Significant psychological trauma due to pain was reported by twopatients. Dreams during anesthesia were reported by 42 patients (3.61%) and five of them stated that the dreams were unpleasant. Conclusions Accidental awareness under GA during CS has a significant incidence in medical centers in the Republic of Srpska (Bosnia and Herzegovina). According to our findings, creating new protocols for GA when performing CS is necessary.

Intravenous Granisetron Combined with Dexamethasone in Cesarean Section Patients Undergoing Spinal Anesthesia

BACKGROUND: Regional anesthesia, including spinal anesthesia, is the technique-of-choice over general anesthesia for cesarean section (C-section). Nausea, vomiting, and shivering are common after spinal anesthesia. Granisetron and dexamethasone are used as a premedication to prevent these reactions. AIM: This study determined the effect of different doses of granisetron combined with dexamethasone for the prevention of nausea, vomiting, and shivering. PATIENTS AND METHODS: This double-blind randomized clinical trial included patients undergoing C-section under spinal anesthesia at several hospitals in Makassar, Indonesia. Forty-five cases were divided into three equal-sized groups: G5, administered intravenous (IV) granisetron at 5 mcg/kg body weight (BW); G10, administered IV granisetron at 10 mcg/kgBW; and G25, administered IV granisetron at 25 mcg/kgBW. All patients also received IV dexamethasone at 0.1 mg/kgBW. RESULTS: In the G10 group, three cases experienced mild nausea, while, in the G5 and G25 groups, there were no incidences of nausea; this was a statistically significant difference (p = 0.043). Vomiting was not reported in any group. The G25 group had the lowest number of patients experiencing shivering (one case with a score of 3), but there were no significant differences in shivering incidence between groups (p = 0.164). CONCLUSION: Granisetron is effective in reducing nausea and shivering at certain dosage.

AIRWAY MANAGEMENT GUIDELINES IN OBSTETRICS.

Anatomic and physiologic changes during pregnancy make it more difficult to establish a safe airway in pregnant women in case of the need for surgery under general anesthesia than in the non-obstetric population. The inability to ventilate and oxygenate is one of the most common causes of morbidity and mortality associated with general anesthesia for cesarean section. The aim of this paper is to present and analyze modern guidelines and algorithms for the management of difficult airway in obstetrics as an important segment of anesthesiology practice. Modern difficult airway management guidelines for pregnant women describe the procedure of difficult facemask ventilation, difficult airway management by using supraglottic devices, difficult endotracheal intubation, and emergency cricothyrotomy or tracheotomy in a situation where oxygenation and ventilation are impossible. Algorithms describe the procedures and equipment for each variant of difficult airway and decision-making strategies in situations when neither airway nor adequate oxygenation can be provided. Croatian anesthesiologists in most obstetric departments have appropriate equipment, as well as necessary experience in difficult airway management for pregnant women, and modern algorithms from the most developed countries can be adopted and accommodated to our daily practice, as well as incorporated into the training curricula of residents.

Supreme laryngeal mask airway for cesarean section under general anesthesia: a 10-year retrospective cohort study.

Previous research showed the use of supraglottic airways in obstetric anesthesia. The relevant evidence of laryngeal mask airway (LMA) on maternal and neonatal outcomes is still limited. We aimed to assess the maternal and neonatal outcomes when the LMA Supreme was used for cesarean section under general anesthesia. We included all patients who underwent general anesthesia for cesarean section between January 2010 and December 2019. Propensity score matching was used to reduce potential bias from non-random selection of airway intervention. The primary outcome was adverse maternal and neonatal outcomes defined as maternal regurgitation, aspiration, hypoxemia, and low neonatal Apgar scores. Secondary outcomes included patient admission to the intensive care unit, neonate required tracheal intubation, external cardiac massage, and admission to the neonatal intensive care unit. A total of 723 patients were included in the analysis; of whom, 221 received Supreme laryngeal mask airway (LMA group) and 502 were intubated with an endotracheal tube (ETT group). After propensity score matching, 189 patients remained in each group. No episode of regurgitation and aspiration occurred in both groups. There was no difference in the rates of Apgar score below 7 at 1 min (14.3% LMA group vs. 15.3% ETT group, OR 0.931, 95% CI 0.574 to 1.510, P = 0.772) and 5 min (3.7% vs. 4.2%, OR 0.875, 95% CI 0.324 to 2.365, P = 0.792). No difference was observed in the secondary outcomes between the two groups. The LMA Supreme was not associated with higher adverse maternal and neonatal outcomes when compared to an endotracheal tube for cesarean section under general anesthesia. It might be considered an alternative to tracheal intubation in obstetric practice.

Factors influencing neonatal outcomes in twin pregnancies undergoing cesarean section: a cross-sectional study

This study aimed to evaluate maternal and fetal characteristics and factors affecting fetal outcomes in twin pregnancies delivered by cesarean section. This was a cross-sectional study in a tertiary care referral hospital. The primary outcome was to ascertain the effects of independent factors on the 1st and 5th minute APGAR scores, neonatal intensive care unit admissions, the need for mechanical ventilation, and neonatal mortality. A total of 453 pregnant women and 906 newborns were included in the analysis. The final logistic regression model revealed that early gestational weeks and neonates <3rd weight percentile at the time of delivery were the most significant predictors of all poor outcome parameters in at least one of the twins (p<0.05). General anesthesia for cesarean section was associated with 1st minute APGAR<7 and the need for mechanical ventilation, and emergency surgery was correlated with the need for mechanical ventilation (p<0.05) in at least one of the twins. General anesthesia, emergency surgery, early gestational weeks, and birth weight <3rd weight percentile were strongly associated with poor neonatal outcomes in at least one of the twins delivered by cesarean section.

Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension: an observational study and nomogram construction

BackgroundPregnant women with pulmonary hypertension (PH) have higher mortality rates and poor foetal/neonatal outcomes. Tools to assess these risk factors are not well established.MethodsPredictive and prognostic nomograms were constructed using data from a “Development” cohort of 420 pregnant patients with PH, recorded between January 2009 and December 2018. Logistic regression analysis established models to predict the probability of adverse maternal and foetal/neonatal events and overall survival by Cox analysis. An independent “Validation” cohort comprised data of 273 consecutive patients assessed from January 2019 until May 2022. Nomogram performance was evaluated internally and implemented with online software to increase the ease of use.ResultsType I respiratory failure, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide ge 1400 ng/L, arrhythmia, and eclampsia with pre-existing hypertension were independent risk factors for maternal mortality or heart failure. Type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, New York Heart Association functional class, and N-terminal pro-brain natriuretic peptide ge 1400 ng/L were independent predictors of pulmonary hypertension survival during pregnancy. For foetal/neonatal adverse clinical events, type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, parity, platelet count, fibrinogen, and left ventricular systolic diameter were important predictors. Nomogram application for the Development and Validation cohorts showed good discrimination and calibration; decision curve analysis demonstrated their clinical utility.ConclusionsThe nomogram and its online software can be used to analyse individual mortality, heart failure risk, overall survival prediction, and adverse foetal/neonatal clinical events, which may be useful to facilitate early intervention and better survival rates.

Intraoperative Awareness During Cesarean Delivery Under General Anesthesia

Background: General anesthesia (GA) for caesarean section (CS) has distinctive characteristics that may increase the risk of awareness during GA (AGA). Objectives: The aim of this study was to investigate the incidence of unintended awareness during GA (AGA) in CS. Materials &amp; Methods: This cross-sectional descriptive study was performed in Alzahra Hospital in Rasht City, Iran. Eligible women with term pregnancy candidates for CS under GA were enrolled in this survey from May 2018 to August 2021. After delivery, a questionnaire including demographic data and questions related to different stages of anesthesia was completed via a faceto- face interview. The collected data were analyzed using repeated measurement, the Chi-square, Fisher exact, and t-test in SPSS v. 21. Results: The data from 174 women were analyzed, and 12 (6.9%) experienced AGA. Among them, dreaming and feeling the manipulation of the surgical area (27.8%) were the most common reported awareness states. Body mass index had a significant (P=0.034) relationship with AGA, but age (P=0.843), the level of education (P=0.714), history of anesthesia (P=0.552), 5-minute Apgar score (P=0.49), and surgery time (P=0.686) had no significant relationship with AGA. Conclusion: The incidence of AGA during CS was almost close to the high limit established by the credible evidence, and a significant number of the women were not in completely acceptable conditions. Therefore, the management of GA for CS should be revised in this academic hospital.

Analgesic effect of ultrasound-guided erector spinae plane block (espb) in general anesthesia for cesarean section: a randomized controlled trial

BackgroundThe analgesic effects of erector spinae plane block in general anesthesia for cesarean section and recovery from puerperae remain unclear.MethodsSixty patients with contraindications for spinal anesthesia who required general anesthesia for cesarean section were enrolled and randomly divided into the erector spinal plane block (ESPB) combined with the general anesthesia group (group E) and general anesthesia group (group G). Group E received bilateral ESPB (20 ml of 0.25% ropivacaine on each side) under ultrasound guidance 30 min before general anesthesia. The primary outcomes were the number of patient-controlled intravenous analgesia (PCIA) boluses, and Bruggemann comfort scale (BCS) scores at 2 h, 6 h, 12 h, and 24 h after operation. The second outcome was intraoperative anesthesia dosage, fetal delivery time, puerperae emergence time, visual analog scale (VAS) at 2 h, 6 h, 12 h, and 24 h after operation, and incidence of nausea and vomiting. Heart rate (HR) and mean arterial pressure (MAP) were recorded 10 min before the start of anesthesia (T0), at the induction of anesthesia (T1), at skin incision (T2), and fetal delivery (T3), and immediately after surgery (T4).ResultsThe number of PCIA boluses was lower in group E than in group G (P < 0.001). The BCS score increased at 2 h and 6 h after the operation in group E (P < 0.05), while the VAS score significantly decreased in group E at the same time (P < 0.05). Compared with group G, the doses of propofol and remifentanil were significantly decreased in group E (P < 0.001), the emergence time of puerperae was shortened (P = 0.003), and the incidence of nausea and vomiting was significantly decreased (P = 0.014).ConclusionUltrasound-guided ESPB applied to general anesthesia for a cesarean section can significantly reduce the required dose of general anesthetic drugs, shorten the recovery time of the puerperae, and improve postoperative analgesia.Trial registration:www.clinicaltrials.gov under the number ChiCTR2200056337 (04–02-2022).

General anesthesia for cesarean section: are we doing it well?

Korea has a higher rate of cesarean sections under general anesthesia than in other countries. Neuraxial anesthesia is the gold standard for a cesarean section, but there are some cases in which general anesthesia is inevitable. Therefore, obstetric anesthesiologists should be familiar in performing general anesthesia for cesarean section. Rapid-sequence induction and intubation with cricoid pressure using thiopental-succinylcholine have been the standard for cesarean section under general anesthesia for a long time. Recently, with the introduction of new drugs (propofol, rocuronium, and sugammadex) and equipments (videolaryngoscopy and supraglottic airways), anesthesia methods have also gradually changed. Pursuing the safety of obstetric patients and anesthesiologists at the same time, this review will help update the knowledge or training in performing general anesthesia for cesarean section.

Neuraxial and general anaesthesia for caesarean section.

Caesarean section (CS) is one of the most performed operations worldwide. In many parts of the world, there has been a reduction in anaesthetic associated obstetric mortality, and this has been attributed to the increased use of neuraxial anaesthesia and improved safety of general anaesthesia, alongside improved training and organisational changes. In resource-limited countries, anaesthesia contributes disproportionately to maternal mortality, with one in seven deaths being due to anaesthesia. A major contributory factor to this is the severe shortage of trained anaesthetic providers. Goals for anaesthesia for CS include the woman's comfort and foetal well-being, focusing on strategies to minimise morbidity and mortality for both. Anaesthetic options for CS include neuraxial techniques (spinal or combined-spinal epidural or epidural extension of labour analgesia) and general anaesthesia. There is increasing evidence of the benefit of neuraxial techniques over general anaesthesia in terms of maternal and foetal outcomes. For elective CS, spinal and combined-spinal anaesthesia predominate. General anaesthesia is mainly reserved for Category 1 CS where there is an immediate threat to the life of the mother or the baby. This review discusses the practical aspects of neuraxial and general anaesthesia for CS.

P.36 Retrospective cross sectional analysis of laryngoscope influence on intubation speed and attempts in general anaesthesia for caesarean section

P.36 Retrospective cross sectional analysis of laryngoscope influence on intubation speed and attempts in general anaesthesia for caesarean section

Comparison of neonatal outcomes of cesarean sections performed under primary or secondary general anesthesia: a retrospective study

BackgroundThe conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA). MethodsWe performed a monocentric retrospective study at the Angers University Hospital (France). All non-elective CSs performed under GA between January 2015 and December 2019 were included. The CSs were classified using a three-color coding system (green for non-urgent delivery, orange for urgent CS, and red for very urgent CS). The primary neonatal outcome was a composite of umbilical artery pH <7.10 or 5-min Apgar score <7. The crude and adjusted odds ratios (OR) for the risk of neonatal morbidity associated with secondary GA were estimated. ResultsWe included 247 patients, of whom 101 (41.3%) had a secondary GA and 146 (58.7%) had primary GA. In the secondary GA group, 86.1% (87/101) had epidural anesthesia and 13.9% (14/101) had spinal anesthesia. Multivariate analysis showed no difference in neonatal morbidity between the two groups (adjusted odds ratio 1.18, 95% CI 0.56 to 2.51). ConclusionsOur study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.