Clinical evaluation of anesthesia for cesarean section at tertiary medical center: retrospective study for 5 years (2009-2013)

Abstract

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Cesarean section anesthesia requires adequate preparation because of maternal physiologic changes, a higher risk for massive maternal bleeding, neonatal considerations, and a higher frequency of emergency operations. Therefore, we retrospectively compared clinical outcomes of cesarean section patients between a high-risk group and non-high-risk group in order to improve anesthesia care. Methods: We reviewed medical records from cesarean section cases at our tertiary medical center for 5 years (2009)(2010)(2011)(2012)(2013). Parameters included the anesthesia and operative time; estimated blood loss, fluid volume and blood products administered during surgery, additional administration of maternal uterotonic medications; as well as the birth weight, Apgar scores, number of neonatal intensive care unit (NICU) admissions, and stillbirth rates of the neonate. Results: The total number of delivery cases was 1935 during the 5 years, and the cesarean section cases accounted for 58.8% (1,138 cases). There were 735 emergency surgery cases (64.6%), and 813 (71.4%) patients were in the high-risk group. Estimated blood loss, fluid volume used, and the frequency and amount of blood transfusions were statistically higher in the high-risk group. Among 1,243 neonates, 918 (73.9%) were born from high-risk mothers. Neonatal birth weights and Apgar scores (1 and 5 minutes) from patients in the high-risk group were statistically lower than those in the non-high-risk group, and NICU admissions and stillbirths were statistically higher in the high-risk group. Conclusions: Anesthesiologists should be aware of unfavorable clinical outcomes in high-risk cesarean section groups and carefully prepare for anesthesia care in these cases. (Anesth Pain Med 2016; 11: 49-54)

Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

“…The rate of general anesthesia increased with the size of hospitals, which was presumably due to the differences in the characteristics of the parturients’ group. One tertiary care hospital reported that 91.2% of cesarean sections were performed under general anesthesia, with 71.4% of parturients in the high-risk groups, and 64.6% of cesarean sections were emergency operations [ 17 ]. A higher number of pregnant women with greater risks and parturients with existing systemic diseases were admitted to tertiary hospitals.…”

Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009–2016)

“…The patients in the high-risk group were divided into six groups as described in our previous paper. 2 In this paper, high-risk cesarean delivery groups with one, two, and three or more risk factors were classified into groups A, B, and C, respectively. Then, we reviewed the patients’ medical records and recorded the following characteristics: patient’s age, duration of anesthesia, duration of operation, estimated blood loss (EBL), the amount of intraoperative infusion solution administered, frequency of intraoperative red blood cell (RBC) transfusions, volume of transfused RBCs, and additional administration of uterotonics.…”

“…We previously reported that high-risk pregnancy had unfavorable clinical outcomes for both the mothers and newborns compared with non-high-risk pregnancy. 2 We now report the differences within the high-risk group. The reported percentage of high-risk pregnancies ranges from 6% to 30% because the situations and conditions that constitute high-risk pregnancy are varied.…”

“…Previously, we retrospectively compared the clinical outcomes over 5 years of high-risk and non-high-risk patients receiving cesarean section. 2 Here, we further investigate high-risk patients. The term "high-risk pregnancy" includes all situations where the risks for both the mother and fetus are increased during pregnancy or delivery.…”

General anesthesia for cesarean section: are we doing it well?

“…In Korea, unlike previous data from the United Kingdom or the United States, the rate of general anesthesia use is steadily decreasing with time, but it is still over 20% [ 14 ]. In some hospitals with a high volume of emergency cases or high-risk parturients, the rate of general anesthesia is close to 90% [ 15 ]. Racial, ethnic, and socioeconomic disparities also contribute to the choice of general anesthesia [ 11 ].…”