Impact of uterine exteriorisation on intraoperative nausea or vomiting during caesarean delivery under neuraxial anaesthesia

Abstract Background: COVID-19 continues to spread globally and results in additional challenges for perioperative management in parturients. The purpose of this study was to determine the incidence and identify associated factors for neuraxial anaesthesia-related hypotension in COVDI-19 parturients during caesarean delivery.Methods: We performed a multicenter case-control study at 3 medical institutions in Hubei province, China form 1th January to 30th May 2020. All ASA Physical Status II full termed pregnant women who received caesarean delivery under neuraxial anaesthesia were eligible for inclusion. The univariate analysis and binary logistic regression analysis were used to identified the independent predictors of neuraxial anaesthesia-related hypotension.Results: Present study included 102 COVID-19 parturients. The incidence of neuraxial anaesthesia-related hypotension was 58%. Maternal abnormal lymphocyte count (OR = 3.41, p = 0.03), full stomach (OR = 3.22, p = 0.04), baseline heart rate (OR = 1.04, p = 0.03), experience of anaesthetist (OR = 0.86, p = 0.02) and surgeon (OR = 0.76, p = 0.03), and combined spinal-epidural anaesthesia technique (OR = 3.27, p = 0.02) were associated with neuraxial anaesthesia-related hypotension. The area under the receiver operating characteristic curve achieved 0.83 which was significantly higher than 0.5 (p < 0.001). And the sensitivity, specificity and percentage correct were 75%, 79% and 75%, respectively. The Hosmer-Lemeshow test showed a good calibration of the model (H = 2.01, DF = 8, p = 0.98).Conclusions: Maternal abnormal lymphocyte count, full stomach, baseline heart rate, experience of anaesthetist and surgeon, and combined spinal-epidural anaesthesia technique were identified as the independent predictors of neuraxial anaesthesia-related hypotension.

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General anaesthesia is associated with increased risk of surgical site infection after Caesarean delivery compared with neuraxial anaesthesia: a population-based study

British Journal of Anaesthesia ◽

10.1093/bja/aer262 ◽

2011 ◽

Vol 107 (5) ◽

pp. 757-761 ◽

Cited By ~ 31

Author(s):

P.-S. Tsai ◽

C.-S. Hsu ◽

Y.-C. Fan ◽

C.-J. Huang

Keyword(s):

Surgical Site Infection ◽

General Anaesthesia ◽

Caesarean Delivery ◽

Population Based ◽

Site Infection ◽

Population Based Study ◽

Neuraxial Anaesthesia ◽

Increased Risk

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Intraoperative management of inadequate neuraxial anaesthesia

10.1093/med/9780198713333.003.0021 ◽

2016 ◽

Author(s):

Tauqeer Husain ◽

Roshan Fernando

Keyword(s):

Caesarean Delivery ◽

Psychological Effects ◽

Mortality And Morbidity ◽

Maternal Risk ◽

Factors Associated ◽

Neuraxial Anaesthesia ◽

Intraoperative Management ◽

Causes And Risk Factors ◽

Primary Form

Neuraxial anaesthesia (NA) is the primary form of anaesthesia used for caesarean delivery. The popularity of NA has increased in no small part due to improvements in mortality and morbidity associated with the techniques. However, intraoperative inadequacy of NA might expose patients to the risks of repeated NA techniques, general anaesthesia, and the long-term psychological effects of pain during caesarean delivery. Additionally, clinicians may also become exposed to the medicolegal consequences of failed NA. Prevention of failed NA requires a sound knowledge of the causes and risk factors associated with inadequate NA. Furthermore, an understanding of the effects of different local anaesthetic mixtures, and methods of testing anaesthetic adequacy are also needed. Decisions in the management of inadequate NA must be taken in the context of the urgency of delivery, the maternal risk, and at what point during the operative episode the inadequacy becomes evident.

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Neuraxial anaesthesia for caesarean delivery

10.1093/med/9780198713333.003.0020 ◽

2016 ◽

Author(s):

Sarah L. Armstrong ◽

Michelle Walters ◽

Katherine Cheesman ◽

Geraldine O’Sullivan

Keyword(s):

Local Anaesthetic ◽

Epidural Anaesthesia ◽

Caesarean Delivery ◽

Preoperative Assessment ◽

Single Shot ◽

Failed Intubation ◽

Continuous Spinal Anaesthesia ◽

Neuraxial Blockade ◽

Neuraxial Anaesthesia ◽

Spinal Epidural

Neuraxial anaesthesia is the safest and preferred method of anaesthesia for both elective and emergency caesarean delivery. It has significant advantages over general anaesthesia including the avoidance of failed intubation and ventilation, awareness, and aspiration of pulmonary contents. It also allows the partner to be present at delivery and facilitates maternal–newborn bonding. This chapter examines the indications and contraindications to neuraxial blockade for caesarean delivery and discusses preoperative assessment and consent for these patients. Neuraxial techniques for caesarean delivery include single-shot spinal, combined spinal–epidural, epidural anaesthesia, and continuous spinal anaesthesia. These techniques are described and critically evaluated. The choice of local anaesthetic drugs and adjuvants is also discussed along with a troubleshooting section for dealing with unexpected complications of neuraxial blockade for caesarean delivery.

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