Raghavan G, Siddiqui N, Whittle W, Downey K, Ye X Y, Carvalho J C A
Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada.
Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.
J Anesth. 2025 Feb;39(1):23-30. doi: 10.1007/s00540-024-03411-8. Epub 2024 Oct 9.
While regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates.
This was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes.
Abnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)).
Abnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.
虽然剖宫产（CD）采用区域麻醉（RA）被认为优于全身麻醉（GA），但某些情况下需要全身麻醉。本研究回顾了剖宫产全身麻醉的应用模式，以确定全身麻醉的可改变预测因素，目标是降低全身麻醉率。
这是一项回顾性病例对照研究。确定了3年内接受紧急剖宫产的患者，从中随机选择102例接受全身麻醉的患者和102例接受区域麻醉的患者。数据包括患者特征、剖宫产的产科指征、麻醉类型/指征、气道管理（全身麻醉组）/神经轴麻醉（区域麻醉组）的特征以及新生儿结局。
异常胎心率（aFHR）是病例组（39%）和对照组（39%）紧急剖宫产最常见的产科指征。全身麻醉最常见的原因是“由于母婴情况危急导致时间有限”（56%），其次是“产妇区域麻醉禁忌”（25%）和“区域麻醉效果不佳”（17%）。全身麻醉最常见的可改变麻醉指征是神经轴麻醉效果不佳（17%）。全身麻醉的麻醉和产科预测因素包括美国麻醉医师协会（ASA）分级[比值比（OR）0.11（0.06 - 0.21）]、启动急救代码[OR 13.55（1.73 - 106.40）]、产程停滞[OR 0.15（0.06 - 0.36）]、计划剖宫产患者的临产[OR 0.16（0.05 - 0.57）]、妊娠相关疾病[OR 8.63（1.06 - 70.38）]、脐带/胎儿脱垂[14.85（1.90 - 115.94）]以及孕周（OR 0.86（0.81 - 0.92））。
异常胎心率，特别是心动过缓，是紧急剖宫产全身麻醉最常见的产科指征，而神经轴麻醉效果不佳是最可改变的麻醉指征。我们的数据表明，在某些情况下，异常胎心率和脐带/胎儿脱垂可能是全身麻醉的可改变风险因素。
