Document Detail

Perioperative anaesthetic management of high-order repeat caesarean section: audit of practice in a university-affiliated medical centre.
MedLine Citation:
PMID:  19665365     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: High-order (five or more) repeat caesarean sections (HORCS) are associated with increased rates of placenta praevia, placenta accreta and peripartum hysterectomy and prolonged surgical time secondary to intra-abdominal adhesions. This study summarizes our experience in the anaesthetic management of HORCS. METHODS: The files of all parturients undergoing HORCS between January 1995 and August 2007 were reviewed to determine surgical times, rates and causes of conversion from neuraxial to general anaesthesia and the need to supplement neuraxial anaesthesia with intravenous sedation. RESULTS: Parturients (n=108) were 35+/-4.5 years old with a gestational age of 37.5+/-1.5 weeks, weighed 88+/-20 kg and had undergone 6+/-1 caesarean sections. Eighty-six (80%) were elective. Initial anaesthetic techniques included spinal (n=80, 74%), epidural (n=9, 8%), combined spinal-epidural (n=6, 6%) and general anaesthesia (n=13, 12%). Surgery lasted 38+/-19 min (median 34, range 9-120). Fourteen parturients (13%) underwent intraoperative manipulations other than caesarean section, including three hysterectomies for haemorrhage (two placenta accreta, one praevia). There were no ruptures or dehiscences of the uterine scar, intraoperative bladder/ bowel injuries or re-explorations. Apgar scores <9 at 1 (n=9, 13%) and 5 (n=6, 5%) min were related to non-anaesthetic causes. Anaesthesia was converted from neuraxial to general in five cases (5/95, 5%) but only two were due to haemorrhage. No epidural top-up doses or intravenous sedatives/analgesics were required for spinal anaesthesia. CONCLUSION: HORCS is not necessarily an indication for general anaesthesia provided uterine and placental abnormalities are sought preoperatively. In our practice single-shot spinal anaesthesia sufficed for uncomplicated HORCS.
A Ioscovich; E Mirochnitchenko; S Halpern; A Samueloff; S Grisaru-Granovsky; Y Gozal; S Einav
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Publication Detail:
Type:  Journal Article     Date:  2009-08-07
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  18     ISSN:  1532-3374     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-28     Completed Date:  2009-12-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  314-9     Citation Subset:  IM    
Departments of Anesthesiology, Perioperative Medicine and Pain Treatment, Obstetrics and Gynecology and the Intensive Care Unit of the Shaare Zedek Medical Centre, Hebrew University, POB 3235, Jerusalem 91031, Israel.
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MeSH Terms
Analgesia, Epidural
Analgesia, Obstetrical
Anesthesia, General
Anesthesia, Obstetrical*
Anesthesia, Spinal
Apgar Score
Cesarean Section, Repeat* / adverse effects
Erythrocyte Transfusion
Hospitals, University
Infant, Newborn
Intraoperative Complications / epidemiology
Medical Audit
Monitoring, Intraoperative
Surgical Procedures, Elective
Surgical Wound Dehiscence
Uterus / injuries
Young Adult
Reg. No./Substance:
0/Oxytocics; 50-56-6/Oxytocin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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