Document Detail


Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section.
MedLine Citation:
PMID:  16879460     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS). METHODS: For 6 months, we prospectively studied women undergoing CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, followed by bupivacaine 0.1% and fentanyl (2 microg/ml) 10-15 ml/h and an additional 5 ml of bupivacaine 0.125% as top-up according to patient request. Sixteen milliliters of lidocaine 2%, 1 ml of bicarbonate and 100 microg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia. RESULTS: Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient age (P = 0.014) and directly correlated with pre-pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top-ups (P = 0.0004) and visual analog scale (VAS) score 2 h before CS (P = 0.03). In multivariate analysis, the number of top-ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio, 4.39; P = 0.005). CONCLUSION: Younger, more obese parturients at a higher gestational week, requiring more top-ups during labor and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
Authors:
S Orbach-Zinger; L Friedman; A Avramovich; N Ilgiaeva; R Orvieto; J Sulkes; L A Eidelman
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  50     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-01     Completed Date:  2006-12-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  793-7     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Rabin Medical Center/Beilinson Campus, Petach-Tiqva 49100, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia, Epidural*
Analgesia, Obstetrical*
Analgesics, Opioid
Anesthesia, Epidural*
Anesthesia, General
Anesthesia, Obstetrical*
Anesthetics, Intravenous
Anesthetics, Local
Bupivacaine
Cesarean Section*
Emergencies
Female
Fentanyl
Humans
Labor Pain / therapy
Labor, Obstetric*
Pregnancy
Risk Factors
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Intravenous; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 437-38-7/Fentanyl

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