ABSTRACT
A retrospective analysis was performed on 19,259 deliveries that occurred in our institution from January 2000 to December 2002. Anesthesia records and quality assurance data sheets were reviewed for the characteristics and failure rates of neuraxial blocks performed for labor analgesia and anesthesia. The neuraxial labor analgesia rate was 75% and the overall failure rate was 12%. After adequate analgesia from initial placement, 6.8% of patients had subsequent inadequate analgesia during labor that required epidural catheter replacement. Ultimately 98.8% of all patients received adequate analgesia even though 1.5% of patients had multiple replacements. Six percent of epidural catheters had initial intravenous placement but 46% were made functional by simple manipulations without higher subsequent failure. Unintended dural puncture occurred in 1.2% of labor neuraxial analgesia. The incidences of overall failure, intravenous epidural catheter, wet tap, inadequate epidural analgesia and catheter replacement were lower in patients receiving combined spinal-epidural versus epidural analgesia. For cesarean section, 7.1% of pre-existing labor epidural catheters failed and 4.3% of patients required conversion to general anesthesia. Spinal anesthesia for cesarean section had a lower failure rate of 2.7%, with 1.2% of the patients requiring general anesthesia. The overall use of general anesthesia decreased from 8% to 4.3% over the three-year period. Furthermore, regional anesthesia was used in 93.5% of cesarean deliveries with no anesthetic-related mortalities. Future investigations should identify acceptable international standards, risk factors associated with failure and methods to reduce failure before cesarean section.
Subject(s)
Analgesia, Obstetrical , Anesthesia, Obstetrical , Nerve Block , Adult , Analgesia, Obstetrical/adverse effects , Anesthesia, Epidural , Anesthesia, General , Anesthesia, Obstetrical/adverse effects , Anesthesia, Spinal , Cesarean Section , Databases, Factual , Delivery, Obstetric , Female , Humans , Nerve Block/adverse effects , Pregnancy , Retrospective Studies , Total Quality Management , Treatment FailureSubject(s)
Hypertension/prevention & control , Intubation, Intratracheal/adverse effects , Nitroglycerin/therapeutic use , Pre-Eclampsia/physiopathology , Adult , Cesarean Section , Drug Evaluation , Female , Fetus/drug effects , Humans , Hypertension/etiology , Infant, Newborn , Infusions, Parenteral , Pregnancy , Random AllocationABSTRACT
Thirty-two healthy term parturients undergoing elective cesarean section randomly received either no antacid (n = 10), 30 ml of 0.3 molar sodium citrate less than 60 min preoperatively (n = 11), or 30 ml of 0.3 molar sodium citrate longer than 60 min preoperatively (n = 11). Immediately after delivery, the stomach was emptied as completely as possible through a #18 Salem Sump tube passed orally. Mean gastric pH in the three groups was 1.8 +/- 2.7 (SD), 5.0 +/- 1.5, and 2.7 +/- 1.2, respectively. Gastric pH was significantly higher in the short interval group than in either the control group or in patients receiving their sodium citrate more than 60 min in advance. Gastric volumes were similar. All control patients had a gastric pH less than 2.5. Nine percent of patients receiving sodium citrate less than 60 min in advance and 50% of patients receiving their sodium citrate longer than 60 min in advance had a pH of less than 2.5. Volumes exceeding 25 ml occurred with equal frequency. No patient in the short interval group had a combination of both pH of less than 2.5 and a volume exceeding 25 ml. This combination occurred with equal frequency in control patients (64%) and in those patients receiving their sodium citrate more than 60 min in advance (50%). We conclude that sodium citrate effectively increases gastric pH when given less than 60 min prior to the induction of anesthesia.
Subject(s)
Cesarean Section , Citrates/therapeutic use , Pneumonia, Aspiration/prevention & control , Premedication , Adult , Citric Acid , Female , Gastric Acidity Determination , Gastric Emptying , Gastrointestinal Contents , Humans , Pregnancy , Time FactorsABSTRACT
The pH and volume of gastric contents from thirty-three patients undergoing elective caesarean section with thiopentone, nitrous oxide, succinylcholine anaesthesia were examined. Twenty patients received Gelusil 30 ml by mouth and thirteen patients received 30 ml of a 0.15 molar solution of sodium citrate. Following tracheal intubation, gastric fluid was sampled through an 18 French Salem sump tube place orally. Mean pH following Gelusil was 4.54 +/- 2.45 (SD) and 2.29 +/- 1.77 following sodium citrate. This difference was statistically different (P less than 0.05). There was no difference in gastric volume between the two groups. Thirty five per cent of patients receiving Gelusil had a pH less than 2.5. This low pH was more likely to occur with prolonged intervals between drug administration and sampling. Significantly more patients receiving sodium citrate had a low pH (85 per cent) and this low pH was not related to the duration of interval between administration and sampling. This study demonstrates that 30 ml of 0.15 molar sodium citrate is not a satisfactory alternative to 30 ml of Gelusil for increasing gastric pH in the paturient when given sixty minutes before operation.
