Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, California.
Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Am J Perinatol. 2022 Feb;39(3):232-237. doi: 10.1055/s-0041-1739355. Epub 2021 Nov 29.
To examine whether the duration of time from initiation of general endotracheal anesthesia (GETA) to delivery for cesarean deliveries (CDs) performed is related to perinatal outcomes.
This is a retrospective study of patients with singleton nonanomalous gestations undergoing CD ≥37 weeks of gestation under GETA with reassuring fetal status at a single tertiary care center from 2000 to 2016. Duration from GETA initiation until delivery was calculated as the time interval from GETA induction to delivery (I-D), categorized into tertiles. Outcomes for those in the tertile with the shortest I-D were compared with those in the other two tertiles. The primary perinatal outcome was a composite of complications (continuous positive airway pressure or high-flow nasal cannula for ≥2 consecutive hours, inspired oxygen ≥30% for ≥4 consecutive hours, mechanical ventilation, stillbirth, or neonatal death ≤72 hours after birth). Secondary outcomes were 5-minute Apgar score <7 and a composite of maternal morbidity (bladder injury, bowel injury, and extension of hysterotomy). Bivariable and multivariable analyses were used to compare outcomes.
Two hundred eighteen maternal-perinatal dyads were analyzed. They were dichotomized based on I-D ≤4 minutes (those in the tertile with the shortest duration) or >4 minutes. Women with I-D >4 minutes were more likely to have prior abdominal surgery and less likely to have labored prior to CD. I-D >4 minutes was associated with significantly increased frequency of the primary perinatal outcome. This persisted after multivariable adjustment. In bivariable analysis, 5-minute Apgar <7 was more common in the group with I-D >4 minutes, but this did not persist in multivariable analysis. Frequency of maternal morbidity did not differ.
When CD is performed at term using GETA without evidence of nonreassuring fetal status prior to delivery, I-D interval >4 minutes is associated with increased frequency of perinatal complications.
· Cesarean delivery under general anesthesia is associated with increased perinatal complications.. · Perinatal complications are increased with increasing duration of exposure to general anesthetics.. · Maternal complications were not increased with shorter duration of exposure to general anesthesia..
探讨全身气管内麻醉（GETA）开始至剖宫产（CD）分娩的时间间隔是否与围产结局有关。
这是一项回顾性研究，纳入了 2000 年至 2016 年在一家三级保健中心接受 GETA 下≥37 孕周、胎儿状态稳定的单胎非畸形妊娠患者。从 GETA 诱导到分娩的时间间隔（I-D）被计算为 GETA 诱导至分娩的时间，分为三分位。比较 I-D 最短三分位组与其他两个三分位组的结果。主要围产结局是并发症的综合指标（连续正压通气或高流量鼻导管≥2 小时，吸入氧≥4 小时，机械通气，死胎或新生儿出生后≤72 小时死亡）。次要结局是 5 分钟 Apgar 评分<7 和产妇发病率（膀胱损伤、肠损伤和子宫切开术延长）的综合指标。采用单变量和多变量分析比较结局。
分析了 218 例母婴对。根据 I-D≤4 分钟（最短持续时间组）或>I-D>4 分钟将其分为两组。I-D>I-D>4 分钟的产妇更有可能有腹部手术史，且在 CD 前分娩的可能性较小。I-D>I-D>4 分钟与主要围产结局的发生率显著增加相关。多变量调整后仍如此。在单变量分析中，I-D>I-D>4 分钟组 5 分钟 Apgar<7 的发生率更高，但多变量分析后无统计学意义。产妇发病率无差异。
当在无分娩前非可信赖胎儿状态证据的情况下使用 GETA 进行足月 CD 时，I-D 间隔>I-D>4 分钟与围产儿并发症的发生率增加相关。
·全身麻醉下剖宫产与围产儿并发症增加相关。·全身麻醉暴露时间的延长与围产儿并发症的增加有关。·与全身麻醉暴露时间较短相比，产妇并发症并未增加。
