| Perioperative anaesthetic management of high-order repeat caesarean section: audit of practice in a university-affiliated medical centre. | |
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MedLine Citation:
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PMID: 19665365 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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A Ioscovich; E Mirochnitchenko; S Halpern; A Samueloff; S Grisaru-Granovsky; Y Gozal; S Einav |
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Publication Detail:
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Type: Journal Article Date: 2009-08-07 |
Journal Detail:
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Title: International journal of obstetric anesthesia Volume: 18 ISSN: 1532-3374 ISO Abbreviation: Int J Obstet Anesth Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-09-28 Completed Date: 2009-12-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9200430 Medline TA: Int J Obstet Anesth Country: Netherlands |
Other Details:
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Languages: eng Pagination: 314-9 Citation Subset: IM |
Affiliation:
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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. aioscovich@gmail.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analgesia, Epidural Analgesia, Obstetrical Anesthesia, General Anesthesia, Obstetrical* Anesthesia, Spinal Apgar Score Cesarean Section, Repeat* / adverse effects Erythrocyte Transfusion Female Hospitals, University Humans Infant, Newborn Intraoperative Complications / epidemiology Medical Audit Monitoring, Intraoperative Oxytocics Oxytocin Pregnancy Surgical Procedures, Elective Surgical Wound Dehiscence Uterus / injuries Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Oxytocics; 50-56-6/Oxytocin |
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