Regional Anaesthesia For Caesarean Section Research Articles

INCIDENCE OF HYPOTENSION IN LSCS WITH INTRATHECAL FENTANYL –LOW DOSE BUPIVACAINE COMBINATION AND WITH BUPIVACAINE ALONE: OBSERVATIONAL STUDY

Spinal anesthesia is the most common technique of regional anesthesia for cesarean section with minimal maternal and neonatal complications as compared to general anesthesia which is associated with difcult airway and risk of aspiration. However, hypotension during spinal anesthesia for cesarean section is the most common complication associated with nausea and vomiting, altered mental status and risk of aspiration

Caesarean Section for Placenta Previa: A Retrospective Cohort Study of Anaesthesia Techniques.

Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, 36.24% were performed under regional anaesthesia and 63.76% under general anaesthesia. When compared to general anaesthesia, significantly less regional anaesthesia was used for emergency caesarean section (26% vs. 38.6%, P = .033) and for grade IV placenta previa (50% vs. 68.8%, P = .013). Blood loss was found to be significantly low with regional anaesthesia (P = .005) and posterior placenta (P = .042), while it was found to be high in grade IV placenta previa (P = .024). The odds of requiring blood transfusion were low in regional anaesthesia (odds ratio = 0.122; 95% CI = 0.041-0.36, P = .0005) and posterior placenta (odds ratio = 0.402; 95% CI = 0.201-0.804, P = .010), while they were high in grade IV placenta previa (odds ratio: 4.13; 95% CI = 0.90-19.80, P = .0681). The rate of neonatal deaths and intensive care admission was significantly lower in regional anaesthesia than in general anaesthesia (7% vs. 3% and 9% vs. 3%). The maternal mortality was zero; however, intensive care admission was less in regional anaesthesia compared to general anaesthesia (<1% vs. 4%).Our data demonstrated less blood loss, need for blood transfusion, and better maternal and neonatal outcomes with regional anaesthesia for caesarean section in women with placenta previa.

Evaluation of patient satisfaction about the use of regional anesthesia for cesarean section in the Kingdom of Saudi Arabia.

Regional anesthesia for cesarean delivery has become a popular choice due to with its immediate effect and high frequency of effective blockage. However, patient satisfaction is a critical indicator of anesthetic care quality. This research aimed to determine the mothers' satisfaction levels after they had an elective or emergency cesarean section under regional anesthesia. This noninterventional, descriptive, cross-sectional questionnaire-based study included 327 participants to evaluate patients' satisfaction with regional anesthesia for cesarean section in Saudi Arabia. The research employed descriptive analysis and a modified Likert scale to assess maternal satisfaction. The study considered a P value of ≤0.05 to decide statistical significance. The respondents' overall satisfaction with regional anesthesia services were rated high, and 198 (60.6%) were satisfied with recommending regional anesthesia to others, while only 28 (8.6%) disagreed with recommending regional anesthesia to others. Most participants scored higher satisfaction rates in all areas of the study. About 233 (71.7%) reported satisfaction concerning the anesthesia staff for patients' privacy; nearly 226 (69.1%) agreed with the level of professionalism of the anesthesia team. Also, 253 (77.4%) were satisfied with the anesthesia team's politeness. Our study concluded that a higher satisfaction rate is associated with regional anesthesia among participants who underwent cesarean section.

Effectiveness of prophylactic ondansetron in preventing spinal anesthesia induced hypotension and bradycardia in pregnant mother undergoing elective cesarean delivery: A double blinded randomized control trial, 2021

BackgroundSpinal anesthesia is the most common techniques of regional anesthesia for cesarean section. However, hypotension is the most common complication associated with nausea and vomiting, altered mental status and risk of aspiration. Bradycardia is also a common feature of profound circulatory collapse under neuraxial anesthesia. After verification that, serotonin can induce BJR reflex and can causes bradycardia or hypotension, researchers started to evaluate the effect of ondansetron to decrease BJR reflex in human being. ObjectivesTo assess the effect of prophylactic ondansetron for prevention of spinal induced hypotension and bradycardia in parturients undergoing cesarean delivery from June 1, 2020 to January 30, 2021. Methodology: A double blinded randomized control trial conducted in Dilla university referral hospital by recruiting 70 patients with systematic random sampling technique. Patients were randomized into ondansetron group (n = 35) and control group (n = 35). Mann Whitney U test was used for continuous non-normally distributed data and independent sample t-test for normally distributed data. Mixed ANOVA was used to analysis the interaction of the within and between factors. Categorical variable between the groups were analyzed using fisher exact and chi square test. p -value<0.05 is considered statically significant. ResultThere were no significant differences in the incidence of hypotension between ondansetron (20(57) and saline group (21(60%)). There were no significant difference in incidence of bradycardia among the two groups p > 0.05. Perioperative Phenylephrine consumption was 36.43 ± 45.91 mcg and 32.14 ± 46.79 mcg in ondansetron and saline group respectively with P = 0.700. The incidence of shivering was lower in ondansetron group (11%) than saline group (45%) with (p = 0.04) and the perioperative rescue shivering requirement was higher in saline group (p = 0.00). Conclusionand Recommendations: Prophylaxis administration of intravenous Ondansetron at a dose of 10 mg before spinal anesthesia was not effective in reducing the incidence of hypotension and bradycardia in pregnant women undergoing cesarean section.

For women undergoing regional anesthesia for cesarean section, which medications prevent nausea and vomiting?

For women undergoing regional anesthesia for cesarean section, which medications prevent nausea and vomiting?

Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section.

Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section.

General versus regional anaesthesia for caesarean section indicated for acute foetal distress: a retrospective cohort study

BackgroundAcute foetal distress (AFD) is a life-threatening foetal condition complicating 2% of all pregnancies and accounting for 8.9% of caesarean sections (CS) especially in developing nations. Despite the severity of the problem, no evidence exists as to the safest anaesthetic technique for the mother and foetus couple undergoing CS for AFD. We aimed to compare general anaesthesia (GA) versus regional (spinal and epidural) anaesthesia in terms of their perioperative maternal and foetal outcomes.MethodsWe carried out a retrospective cohort study by reviewing the medical records of all women who underwent CS indicated for AFD between 2015 to 2018 at the Douala General Hospital, Cameroon. Medical records of neonates were also reviewed. We sought to investigate the association between GA, and regional anaesthesia administered during CS for AFD and foetal and maternal outcomes. The threshold of statistical significance was set at 0.05.ResultsWe enrolled the medical records of 117 pregnant women who underwent CS indicated for AFD. Their mean age and mean gestational age were 30.5 ± 4.8 years and 40 weeks respectively. Eighty-three (70.9%), 29 (24.8%) and 05 (4.3%) pregnant women underwent CS under SA, GA and EA respectively. Neonates delivered by CS under GA were more likely to have a significantly low APGAR score at both the 1st (RR = 1.93, p = 0.014) and third-minute (RR = 2.52, p = 0.012) and to be resuscitated at birth (RR = 2.15, p = 0.015). Past CS, FHR pattern on CTG didn’t affect these results in multivariate analysis. Adverse maternal outcomes are shown to be higher following SA when compared to GA.ConclusionThe study infers an association between CS performed for AFD under GA and foetal morbidity. This, however, failed to translate into a difference in perinatal mortality when comparing GA vs RA. This finding does not discount the role of GA, but we emphasize the need for specific precautions like adequate anticipation for neonatal resuscitation to reduce neonatal complications associated with CS performed for AFD under GA.

Evaluating anesthesia practice for caesarean section: A prospective cross-sectional study from a tertiary care institution of low- and middle-income country

Background and Objective: In low and middle-income countries (LMICs), general anesthesia for cesarean section has shown to increase the odds of maternal mortality. Use of regional anesthesia for cesarean section is an indicator for safe practice of anesthesia; therefore, this study aims to evaluate the current practice of use of regional anesthesia and its failure rate for cesarean section. The current practice is analyzed in the light of previously published data from the same institution of LMIC. Methods: After hospital ethics committee approval, this prospective cross-sectional study was performed from January 1 to June 30, 2019. Prospective data collected on predesigned form included technique of anesthesia employed for different category of cesarean section, failure of regional anesthesia, and other related data. The cesarean section rate and trends of technique of anesthesia over last 10 years were collected from hospital record system. Results: Compared to the published data from the year 2012 from the same institution, the results from this prospective data have shown an increase rate of cesarean section rate from 31% to 52% with an overall decline in the use of general anesthesia from 49% to 12.3%. In addition, rate of regional anesthesia for category 1–3 cesarean section has increased from 46.4% to 79.8% and for category 1 from 37.1% to 63.4%. Decline in failure rate of regional technique was observed from 6.7% to 2.4%. Conclusion: Assessing and analyzing practices helps in taking initiative to implement safe practices which are needed to achieve the target for best practice.

The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross-sectional analysis of six hospitals in the north-west of England.

At the onset of the global pandemic of COVID-19 (SARS-CoV-2), guidelines recommended using regional anaesthesia for caesarean section in preference to general anaesthesia. National figures from the UK suggest that 8.75% of over 170,000 caesarean sections are performed under general anaesthetic. We explored whether general anaesthesia rates for caesarean section changed during the peak of the pandemic across six maternity units in the north-west of England. We analysed anaesthetic information for 2480 caesarean sections across six maternity units from 1 April to 1 July 2020 (during the pandemic) and compared this information with data from 2555 caesarean sections performed at the same hospitals over a similar period in 2019. Primary outcome was change in general anaesthesia rate for caesarean section. Secondary outcomes included overall caesarean section rates, obstetric indications for caesarean section and regional to general anaesthesia conversion rates. A significant reduction (7.7 to 3.7%, p<0.0001) in general anaesthetic rates, risk ratio (95%CI) 0.50 (0.39-0.93), was noted across hospitals during the pandemic. Regional to general anaesthesia conversion rates reduced (1.7 to 0.8%, p=0.012), risk ratio (95%CI) 0.50 (0.29-0.86). Obstetric indications for caesarean sections did not change (p=0.17) while the overall caesarean section rate increased (28.3 to 29.7%), risk ratio (95%CI) 1.02 (1.00-1.04), p=0.052. Our analysis shows that general anaesthesia rates for caesarean section declined during the peak of the pandemic. Anaesthetic decision-making, recommendations from anaesthetic guidelines and presence of an on-site anaesthetic consultant in the delivery suite seem to be the key factors that influenced this decline.

Prevention of hypotension during elective cesarean section with a fixed-rate norepinephrine infusion versus a fixed-rate phenylephrine infusion. Α double-blinded randomized controlled trial

BackgroundSpinal anesthesia for cesarean section can be complicated by hypotension, with untoward effects for both the mother and fetus. Frequently used phenylephrine can lead to baroreceptor-mediated reflex bradycardia. The aim of the present study was to compare a fixed-rate prophylactic norepinephrine infusion to a fixed-rate prophylactic phenylephrine infusion during elective cesarean section under combined spinal-epidural anesthesia. Materials and methodsEighty-two parturients were randomized to either norepinephrine 4 μg/min or phenylephrine 50 μg/min fixed-rate infusions, starting simultaneously with the administration of the subarachnoid solution. The primary endpoint was the incidence of maternal bradycardia. Maternal hemodynamics at specific timepoints, the incidence of hypotension or hypertension, the requirement for ephedrine or atropine bolus administration as well as the acid-base status and Apgar score of the neonate were recorded. ResultsThe incidence of bradycardia as well as the requirement for atropine administration was lower in the norepinephrine group (4.8% vs. 31.7%, p = 0.004 and 2.4% vs. 24.3%, p = 0.01, respectively). Fetal pH, and fetal blood glucose concentration were higher in the norepinephrine group (p = 0.027 and 0.019, respectively). No difference in the occurrence of hypotension, hypertension, in the requirement for bolus vasoconstrictive medication or in Apgar scores was demonstrated. ConclusionsA fixed-rate infusion of norepinephrine is as effective in the management of hypotension during regional anesthesia for cesarean section as a fixed-rate infusion of phenylephrine, with the avoidance of phenylephrine-induced bradycardia. The more favourable neonatal acid-base profile of noradrenaline might be due to better maintenance of placental blood flow in the noradrenaline group due to its beta action, while the higher fetal glucose concentration in the same group might result from a catecholamine-stimulated glucose metabolism increase and a β-receptor mediated insulin decrease.

Caesarean section anaesthesia : technique and failure rate over a 10-year period – what has changed?

It is well established that regional anaesthesia for caesarean section has significant safety benefits for women compared to general anaesthesia. The Royal College of Anaesthetists (RCoA) have recommended standards for rates of regional anaesthesia in elective (&gt; 95%) and emergency (&gt; 85%) caesarean sections, as well as rates for conversion from regional to general anaesthesia of &lt; 1% in elective and &lt; 3% in emergency cases. In the current climate and with the concerns surrounding COVID-19, the avoidance of general anaesthesia wherever possible is important as the risk of aerosol generation is reduced.

The Efficacy of low: Dose ketamine for prevention of intraoperative nausea and vomiting during caesarean section under spinal anaesthesia: A comparative study

Background: Intraoperative nausea and vomiting affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about intraoperative nausea and vomiting (IONV) and several in parturient and cesarean. However, it needs more attention. Ketamine is a potential drug in this procedure. Objective: The main objective of the study was to evaluate the efficacy of low-dose ketamine for prevention of intraoperative nausea and vomiting in caesarean section under spinal anaesthesia. Methods: This comparative study was conducted in Department of Anaesthesiology and ICU in Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh during the period from January 2019 to December 2019. In total 120 patients were randomly allocated into two equal groups: the ketamine group; in which 0.5 mg/kg was infused intravenously in 20 min and the placebo group; in which normal saline was infused. The two groups were given subarachnoid block with local anaesthetic hyperbaric 0.5% bupivacaine and intrathecal fentanyl. Results: The incidence of intraoperative nausea was 20% and episodes were 38 in total in the ketamine group compared with 38.33% and episodes were 76 in total in the placebo group, which was statistically significant (P value 0.176). Both vomiting episodes and number of patients who required rescue anti-emetics in the ketamine group compared with placebo one (3.33% vs 6.67% and 2 vs 5 respectively) were not statistically significant P values 0.682 and 0.593. Conclusion: In our study, we found the satisfactory efficacy and better compliance from the patient’s front. Ketamine may be used without hesitation for prevention of intraoperative nausea and vomiting in caesarean section under spinal anaesthesia.

The influence of mode of anaesthesia for caesarean delivery on neonatal Apgar scores in the Czech Republic and Slovakia: secondary analysis of the results of an international survey in 2015.

The purpose of this international survey was to describe the impact of current practices and techniques of caesarean section on the neonatal Apgar score in the Czech Republic (CZE) and Slovakia (SVK). All Czech and Slovak departments that provide obstetric anaesthesia were invited to participate in a one-month (November 2015) prospective study that monitored in details all peripartum anaesthetic practices, delivered by anaesthesiologists. Participating centers recorded all data on-line in the CLADE-IS database (Masaryk University, CZE). We collected data of 10119 women who delivered 10226 newborns. A caesarean section was recorded in 25.1% of deliveries (CZE 23.2%; SVK 30%). General anaesthesia was used for caesarean section in 37.5% of the cases (CZE 40%, SVK 33%). There was no statistically significant difference in the Apgar score lower than 7 in the 1, 5 or 10 min in groups of general and regional anaesthesia for caesarean section, when only elective sections of in-term babies with birth weight over 2500 g were analyzed. We found no statistically significant differences in the Apgar score in newborns of women intubated for caesarean section in rocuronium (n=21; 2.2%) and suxamethonium (n=889; 93%). We found no difference in neonatal outcomes in groups of general and regional anaesthesia for caesarean section when only out-of-risk newborns were analyzed. The risk factors were identified as follows: an acute caesarean section, preterm babies, birth weight less than 2 500 g, born in perinatological center and multiple pregnancy - second baby. ClinicalTrials.gov (ID: NCT02380586) https://clinicaltrials.gov/ct2/show/NCT02380586.

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions.

BackgroundIntraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids.MethodsGiven the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts.Discussion and conclusionTaking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal–epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.

General versus regional anaesthesia for caesarean section: A field study in four Riyadh hospitals, Saudi Arabia.

General versus regional anaesthesia for caesarean section: A field study in four Riyadh hospitals, Saudi Arabia.

Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section.

Bupivacaine is an amide local anaesthetic used in hyperbaric and isobaric forms. These are administered intrathecally into the spine to provide regional anaesthesia for caesarean section. Several trials have compared hyperbaric and isobaric bupivacaine but none have conclusively shown the benefit of either. This review was first published in 2013 and updated in 2016. Our objectives were to:1. Determine the effectiveness of hyperbaric bupivacaine compared to isobaric bupivacaine for spinal anaesthesia in women undergoing caesarean section;2. Determine the safety of hyperbaric bupivacaine compared to isobaric bupivacaine for spinal anaesthesia in women undergoing caesarean section. We originally searched the following databases to January 2011: CENTRAL, MEDLINE and Embase.For this update, we reran our search in the above databases from January 2011 to March 2016; two studies are awaiting a response from authors for assessment and will be dealt with when we next update the review.We imposed no language restriction. We included all randomized controlled trials (RCTs) involving parturients undergoing spinal anaesthesia for elective caesarean section that compared the use of hyperbaric with isobaric bupivacaine. Two authors independently extracted the data. The data that were extracted included the number of events and the sample sizes in both the intervention and control groups. For continuous outcomes, we extracted mean and standard deviation.We reported odds ratios (ORs) and risk ratios (RRs) for binary outcomes, and mean differences (MDs) for continuous outcomes. We included three new RCTs in this update, which now comprises 10 studies with a total of 614 participants. We judged most trials as having uncertain risk of bias regarding randomization. Other than this, the overall risk of bias was low. Most included trials had small sample sizes. All of the trials assessed the primary outcome of conversion to general anaesthesia. Ten trials comparing anaesthesia performed with hyperbaric and isobaric bupivacaine failed to show any difference in need for conversion to general anaesthesia (RR 0.33, 95% CI 0.09 to 1.17, 614 participants, very low quality of evidence). Nine trials also failed to show a difference in the need for supplemental analgesics (RR 0.61, 95% CI 0.26 to 1.41, 554 participants, very low quality of evidence). Four trials comparing requirement for ephedrine did not show any difference (RR 0.89, 95% CI 0.57 to 1.38, 256 participants, very low quality of evidence). Seven trials did not provide convincing evidence of difference in nausea and vomiting (RR 0.99, 95% CI 0.57 to 1.72, 433 participants, low quality of evidence). Three trials failed to show a difference in headache (OR 1.82, 95% CI 0.47 to 6.99, 234 participants, low quality of evidence). Two trials showed that the time until sensory block to the thoracic 4th (T4) spinal level was shorter with hyperbaric bupivacaine (MD -1.06 minutes, 95% CI -1.80 to -0.31, 128 participants, moderate quality of evidence). Six trials showed no difference in the amount of ephedrine used (RR 0.23, 95% CI -1.65 to 2.12, 386 participants, moderate quality of evidence). Three trials failed to show any difference in high block (RR 0.88, 95% CI 0.16 to 4.90, 205 participants). Data are limited for some of the outcomes. Reporting of the included trials is less than optimal. For these reasons the overall quality of evidence is low or very low for most of the outcomes, based on the GRADE method of assessment. This review found that intrathecal hyperbaric bupivacaine had a more rapid onset of sensory blockade at the 4th thoracic vertebra (T4) level than isobaric bupivacaine. Hower, despite incorporating more data in the analysis, we found little evidence that the need for conversion to general anaesthesia and supplemental analgesia differed between the hyperbaric or isobaric bupivacaine groups. This is mainly due to the rarity of these outcomes, variability in the dose, use of adjuvant drugs and differences in the technique used for regional anaesthesia. There were no differences in the adverse effects studied. Any possible advantage of hyperbaric bupivacaine needs to be confirmed in larger randomized trials. In future research, criteria for conversion to general anaesthesia need to be defined objectively and applied uniformly.

Intravenous ketamine during spinal and general anaesthesia for caesarean section: systematic review and meta-analysis.

Intravenous ketamine has been used during general and regional anaesthesia for caesarean section. No systematic review and meta-analysis on the desired effects and adverse effects of ketamine administration during caesarean section have yet been performed. After a systematic literature search a meta-analysis was conducted with the random effects model. Weighted mean difference (WMD) or risk ratio and 95% confidence intervals (CIs) were computed. Twelve randomised controlled double-blind trials comprising 953 patients were included: seven studies reported on spinal anaesthesia and five on general anaesthesia. Significant differences in the aforementioned outcome variables were found only in the spinal anaesthesia studies. In the spinal anaesthesia studies the time to the first analgesic request was significantly longer in ketamine-treated women, the WMD was 49.36 min (95% CI 43.31-55.41); visual analogue scale pain scores at rest 2 h after surgery were significantly lower. No differences were observed for maternal nausea, vomiting, pruritus, and psychomimetic effects. Only few data were found for neonatal outcomes. We conclude that ketamine enhances post-operative analgesia after caesarean section under spinal anaesthesia. There is a paucity of data for several maternal adverse effects as well as for neonatal well-being. Further studies are needed for general anaesthesia.

A comparison of spinal and epidural anesthesia for cesarean section following epidural labor analgesia: A retrospective cohort study

IntroductionThis study aimed to investigate different types of regional anesthesia for cesarean section (CS) following epidural labor analgesia that could lead to various perioperative and postoperative outcomes. MethodsWe retrospectively included those parturients who received epidural labor analgesia but needed subsequent CS under regional anesthesia in our institution from January 2008 to June 2012. ResultsIn all, 2341 of 6609 parturients underwent painless labor, and 334 of them converted to CS. Spinal anesthesia (SA) was used with 163 parturients, and epidural anesthesia (EA) with 96; the two groups were then compared. No high-level block or total SA was noted. The primary outcome revealed that the time from anesthesia to surgical incision and the total anesthesia time were shorter, hypotension episodes were more frequent, the rate of perioperative ephedrine administration was higher, and the rate of midazolam was lower in the SA group. With regard to secondary outcomes, the Apgar scores of the neonates recorded at 1 minute and 5 minutes and maternal satisfaction were similar. The neuraxial morphine dose was converted to parenteral morphine equivalent dose (MED), which revealed that the parturients in the spinal morphine group had lower dosages and visual analog scale (VAS) pain scores on postoperative Day 1. ConclusionFor parturients with labor epidural analgesia needing CS, the use of SA led to shorter anesthetic time and lower postoperative pain scores, with lower morphine doses compared with EA. However, the high failure rate with both neuraxial techniques needs to be addressed.

Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section.

Background and Aims:We aimed to measure the frequency of preoperative anxiety in patients undergoing elective cesarean section (CS) and its impact on patients decision regarding the choice of anesthesia.Material and Methods:This cross-sectional study included 154 consecutive patients, who were scheduled for elective CS. Visual analog scale (VAS) for anxiety was the study tool, and VAS ≥50 was considered as significant anxiety. Enrolled patients were interviewed by the primary investigator the day before the surgery and their VAS score and choice of anesthesia technique either general anesthesia (GA) or regional anesthesia (RA) were recorded. Additional data included demographics, parity, educational status, previous anesthesia experience and source of information.Results:Preoperative anxiety (VAS ≥ 50) was seen in 72.7% of patients, which was significantly higher (P < 0.005) in patients selecting GA (97.18%, n = 71/154) as compared to those selecting RA (51.81%, n = 83/154) for elective CS. Statistically significant association of anxiety (P < 0.005) was seen with age <25 years, nulli and primiparous, higher education status, previous anesthesia experience and source of information from nonanesthetist.Conclusion:Patients scheduled for elective CS were found to have high frequency of anxiety (72.7%), and GA was observed to be the choice of anesthesia technique in anxious patients.

Anaesthetic Method Preference of Obstetricians for Caesarean Section

Anaesthesiologists are applying regional anaesthesia for caesarean section at an increasing rate compared to previous years. In our study, we tried to evaluate the perspective of obstetricians towards this trend. Questionnaires were sent to e-mail addresses of obstetricians via the internet; 195 obstetricians replied. Sex, age, work place, employer, working durations as consultant, preference of anaesthesia for caesarean section and their bias towards regional anaesthesia were asked with these questionnaires. A 5-point Likert scale was used to evaluate their bias towards regional anaesthesia. While 82.1% of obstetricians (n: 160) preferred regional anaesthesia, 17.9% of obstetricians (n: 35) favoured general anaesthesia for caesarean section for both themselves and their primary relatives. However, 80% of the participants opted for regional anaesthesia for their patients; only 20% of the participants still preferred general anaesthesia for caesarean section. Chi-square tests that were used to evaluate the relationship between demographic data and anaesthesia choices of obstetricians for both themselves, their primary relatives and their patients did not reveal any statistically significant differences (p<0.05). A large portion of Turkish obstetricians consider regional anaesthesia a safe procedure and prefer it highly for both themselves and their patients.