The Choice of Anesthesia after First Failed Spinal Block and Its Impact on Maternal and Neonatal Outcomes in Cesarean Delivery: A Cross-Sectional Study
Kwanruthai Narunart¹, Wirat Wasinwong¹, Tippawan Liabsuetrakul²
Affiliation : ¹ Department of Anesthesia, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; ² Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective: The preferred choice of anesthesia for cesarean delivery is spinal block, which has a failure rate of 0.5% to 17.0%. The present study investigated the incident rate of second choice of anesthesia following a failed block, as well as the factors influencing the anesthesiologist’s selection.
Materials and Methods: A single-center, retrospective cross-sectional study was conducted using electronic medical records of parturients who had experienced a failed spinal block for cesarean deliveries between 2014 and 2019. Each rate of repeated spinal block and the conversion to general anesthesia were calculated. Factors associated with the decision-making were examined, and maternal and neonatal outcomes were reviewed.
Results: Three hundred four women were recruited. The rates of repeated block and conversion to general anesthesia were 81.2% and 18.8%, respectively. Dural puncture with more than one attempt (p=0.022) and anesthesia level at the thoracic dermatome (p<0.001) were associated with a lower decision to repeat the block. Maternal in the repeated block group had a higher incidence of hypotension at 59.5% (p<0.001) and shivering at 16.2% (p=0.008). Neonates in the repeat block group had a lower incidence of any complications than those in the conversion to general anesthesia group at 4% versus 29.8% (p<0.001).
Conclusion: Following an unsuccessful spinal block for cesarean section, the repeated block was still preferred. The level of anesthesia and the spinal attempts were the significant factors in this choice.
Received 28 November 2022 | Revised 10 July 2023 | Accepted 18 July 2023
DOI: 10.35755/jmedassocthai.2023.08.13875
Keywords : Cesarean delivery; Conversion to general anesthesia; Failed spinal block; Maternal and neonatal outcomes; Repeat block
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