Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study

• Published in: Canadian journal of anesthesia 2009-08, Vol.56 (8), p.577-583
• Main Authors: Visser, W. Anton, Dijkstra, Annemieke, Albayrak, Mustafa, Gielen, Mathieu J. M., Boersma, Eric, Vonsée, Henk J.
• Format: Article
• Language: English
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Adult; Analgesia, Epidural - methods; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Obstetrical - methods; Anesthesia, Spinal - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Apgar Score; Biological and medical sciences; Blood Pressure - drug effects; Cardiology; Catheters; Cesarean section; Cesarean Section - methods; Childbirth & labor; Clinical medicine; Cohort analysis; Cohort Studies; Critical Care Medicine; Drug dosages; Epidural; Female; General anesthesia; Humans; Intensive; Intubation; Medical personnel; Medical sciences; Medicine; Medicine & Public Health; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Reports of Original Investigations; Retrospective Studies
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-009-9113-y

Purpose Failed conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum Cesarean delivery (CD) has been observed in clinical practice. However, spinal anesthesia (SA) in parturients experiencing failed conversion of ELA to ESA has been associated with an increased incidence of serious side effects. In this retrospective cohort analysis, we examined our routine clinical practice of removing the in situ epidural, rather than attempting to convert to ESA, prior to administering SA for intrapartum CD. Methods Hemodynamic data, frequencies of either high or total spinal block, and maternal and neonatal outcome data were gathered from the anesthesia records of all parturients at the Amphia Hospital, undergoing intrapartum CD between January 1, 2001 and May 1, 2005. Results Complete data were available for 693 patients (97.6%) of the 710 medical records that were identified. Of the 693 patients, 508 (73.3%) had no ELA and received SA, 128 patients (18.5%) received SA following epidural anesthesia for labor, 19 (2.7%) underwent conversion of ELA to ESA, and 38 (5.5%) received general anesthesia. When comparing both SA groups, no clinically relevant differences were observed regarding the incidence of total spinal block (0% in both groups) or high spinal block (0.2 vs 0.8%, P  = 0.36). The number of hypotensive episodes, the total amount of ephedrine administered, and the Apgar scores recorded at 5 and 10 min were similar amongst groups. Conclusions The incidence of serious side effects associated with SA for intrapartum CD following ELA is low and not different compared to SA only.