Anaesthetic management in emergency cesarean section: Systematic literature review of anaesthetic techniques for emergency C-section
The literature related with the anesthetic management of emergent C section is limited, for which reason we proposed the systematic evaluation of the existing literature on anesthetic management of obstetric patients undergoing emergency cesarean section in order to define the most appropriate interventions based on evidence. A systematic review of the literature was undertaken in MEDLINE, 1966 to December 2010, Cochrane Collaboration registry of clinical trials, Cochrane systematic review database, and LILACS. The study selection process was undertaken independently by two researcher-reviewers, who identified controlled clinical trials and cohort studies of anaesthetic management in emergency C-section. The data were extracted, reviewed and subjected to quality evaluation in duplicate fashion. In total, 2,297,36,221 were examined, respectively, and of those 16 potentially relevant papers, 9 clinical trials and 7 observational studies were included in the study. A heterogeneity analysis was done using I2, with a result of 52%, and for this reason no meta-analysis was conducted.
Conclusions: The anaesthetist plays a critical part in mother-and-child care, prioritization of the C-section urgency, peridural anaesthesia extension with 2% lidocaine plus adjuvants (fentanyl plus fresh adrenaline), the use of vasopressors (phenylephrine, ephedrine) for the aggressive management of hypotension, the use of oxygen supplementation and the adequate management of general anaesthesia when indicated, contributing to a favourable impact on the outcome for both the mother and the baby. Long-term neonatal outcomes are not influenced by the type of anaesthesia given to the mother.
2. NHS Maternity Statistics, 2008-2009 [consultado 31 Ene 2011]. Disponible en: http://www.ic.nhs.uk/statistics-anddata-collections/hospitalcare/maternity/nhs-maternity-statistics-2008-09.
3. Menacker F, Hamilton BE. Recent trends in cesarean delivery in the United States. National Center for Health Statistics, Division of Vital Statistics, Reproductive Statistics Branch. Data Brief No. 35, March 2010 [consultado 31 Ene 2011]. Disponible en: http://www.cdc.gov/nchs
4. Associated Press. C-section rates around globe at 'epidemic' levels [consultado 31 Ene 2011]. Disponible en: http://www.msnbc.msn.com
5. Graphs of historical caesarean section rates [consultado 31 Ene 2011]. Disponible en:http://www.birthchoiceuk.com/Professionals/CSHistory.htm
6. National Institute of Health and Clinical Excellence. Clinical Guideline 13: Caesarean section; 2004 [consultado 31 Ene 2011]. Disponible en: http://guidance.nice.org.uk/CG13/Guidance/pdf/English
7. Lucas DN, Yentis SM, Kinsella SM, Holdcroft A, May AE, Wee M, et al. Urgency of caesarean section: a new classification. J R Soc Med. 2000;93:346-50.
8. Lewis G, editor. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer - 2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007.
9. Davies JM, Posner KL, Lee LA, Cheney FW, Domino KB. Liability associated with obstetric anesthesia: a closed claims analysis. Anesthesiology. 2009;110:131-9.
10. Royal College of Obstetricians & Gynaecologists Classification of urgency of caesarean section- a continuum of risk. RCOG Press, 2010 [consultado 30 Ene 2011]. Disponible en: http://www.rcog.org.uk/
11. Cochrane [base de datos en internet]. CENTRAL y la librería Cochrane, Issue 2 2010, Cochrane Central Register of Controlled Trials (CENTRAL) [consultado 19 Dic 2010]. Disponible en: http://www.thecochranelibrary.com/view/0/index.html
12. PubMed [base de datos en internet]. Bethesda: National Library of Medicine, 1966 [consultado Dic 2010]. Disponible en: http://www.ncbi.nlm.nih.gov/PubMed/
13. Lilacs [base de datos en Internet]. Literatura latinoamericana y del Caribe en Ciencias de la Salud [consultado 19 Dic 2010]. Disponible en: http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&base=LILACS&lang=i&form=F
14. Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006:CD004350.
15. Hofmeyr GJ, Mathai M, Shah AN, Novikova N. Techniques for caesarean section. Cochrane Database of Systematic Reviews. 2008;(Issue 1), http://dx.doi.org/10.1002/14651858.CD004662.pub2. CD004662.
16. Scottish Intercollegiate Guidelines Network. Methodology Review Group. Report on the review of the method of grading guideline recommendations. Edinburgh: SIGN; 1999.
17. Scottish Office. Clinical Resources and Audit Group. Clinical guidelines: report by a working group. Edinburgh: Scottish Office; 1993.
18. Higgins JPT, Green S (eds.). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [consultado Feb 2008]. The Cochrane Collaboration. Disponible en www.cochrane-handbook.org
19. Savidis A, Ammari A, Iatrou Ch, Maroulis G. The contribution of anaesthesia modus on reducing blood loss during caesarean section. Liberis V, Tsikouras P, Vogiatzaki T, 2009.
20. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
21. Kinsella SM, Walton B, Sashidharan R, Draycott T. Category-1 caesarean section: a survey of anaesthetic and peri-operative management in the UK. Anaesthesia. 2010;65:362-8.
22. Chau-in W, Hintong T, Rodanant O, Lekprasert V, Punjasawadwong Y, Charuluxananan S, et al. Anesthesia-related complications of caesarean delivery in Thailand: 16,697 cases from the Thai Anaesthesia Incidents Study. J Med Assoc Thai. 2010;93:1274-83.
23. Kinsella S. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia. 2008;63:822-32.
24. Regan KJ, O'Sullivan G. The extension of epidural blockade for emergency Caesarean section: a survey of current UK practice. Anaesthesia. 2008;63:136-42.
25. Gori F, Pasqualucci A, Corradetti F, Milli M, Peduto VA. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med. 2007;20:53-7.
26. Sprung J, Flick RP, Wilder RT, Katusic SK, Pike TL, Dingli M, et al. Anesthesia for cesarean delivery and learning disabilities in a population-based birth cohort. Anesthesiology. 2009;111:302-10.
27. Pallasmaa N, Ekblad U, Aitokallio A, Uotila J, Raudaskoski T, Ulander VM, et al. Cesarean delivery in Finland: maternal complications and obstetric risk factors. Acta Obstet Gynecol Scand. 2010;89:896-902.
28. Wallace DH, Leveno KJ, Cunningham FG, Giesecke AH, Shearer VE, Sidawi JE. Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia. Obstet Gynecol. 1995;86:193-9.
29. Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James MF. A randomised trial comparing general with spinal anaesthesia for caesarean section in preeclamptics with a non-reassuring fetal heart trace. BJOG. 2003;12:202.
30. Goring-Morris J, Russell IF. A randomised comparison of 0.5% bupivacaine with a lidocaine/epinephrine/fentanyl mixture for epidural top-up for emergency caesarean section after «low dose» epidural for labour. Int J Obstet Anesth. 2006;15:109-14.
31. Malhotra S, Yentis SM. Extending low-dose epidural analgesia in labour for emergency Caesarean section - a comparison of levobupivacaine with or without fentanyl. Anaesthesia. 2007;62:667-71.
32. Sng BL, Pay LL, Sia AT. Comparison of 2% lignocaine with adrenaline and fentanyl, 0.75% ropivacaine and 0.5% levobupivacaine for extension of epidural analgesia for urgent caesarean section after low dose epidural infusion during labour. Anaesth Intensive Care. 2008;36: 659-64.
33. Allam J. Epidural lidocaine-bicarbonate-adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial. Anaesthesia. 2008;63:243-9.
34. Balaji P, Dhillon P, Russell IF. Low-dose epidural top up for emergency caesarean delivery: a randomised comparison of levobupivacaine versus lidocaine/epinephrine/fentanyl. Int J Obstet Anesth. 2009;18:335-41.
35. Ngan Kee WD, Lee A, Khaw KS, Ng FF, Karmakar MK, Gin T. Randomised double-blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non-elective Caesarean section. Anaesthesia. 2008;63:1319-26.
36. Khaw K, Wang CC, Ngan Kee WD, Tam WH, Ng FF, Critchley LA, et al. Supplementary oxygen for emergency Caesarean section under regional anaesthesia. Br J Anaesth. 2009;102:90-6.
37. Wee M, Brown H, Reynolds F. The national institute of clinical excellence (NICE) guidelines for caesarean sections: implications for the anaesthetics. BJOG. 2005;14:147-58.
38. Andrews WW, Ramin SM, Maberry MC, Shearer V, Black S, Wallace DH. Effect of type of anesthesia on blood loss at elective repeat cesarean section. Am J Perinatol. 1992;9:197-200.
39. Lertakyamanee J, Chinachoti T, Tritrakarn T, Mugangkasem J, Somboonnanonda A, Kolatat T. Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial. BJOG. 1999;82:672-80.
40. Ng KW, Parsons J, Cyna AM. Spinal versus epidural anaesthesia for caesarean. Cochrane Database Syst Rev. 2004:CD003765.
41. Afolabi BB. Regional vs general anesthesia for cesarean section. Cochrane Database Syst Rev. 2006:CD004350.
42. Vasco Ramírez M, Lopera LM. Técnicas intravenosas para operación cesárea. Rev Col Anest. 2006;34, 35.
43. Fortescue C, Wee MY, Malhotra S, Yentis SM, Holdcroft A. Is preparation for emergency obstetric anaesthesia adequate? A maternal questionnaire survey. Int J Obstet Anesth. 2007;16:336-40.
44. Schewe JC, Komusin A, Zinserling J, Nadstawek J, Hoeft A, Hering R. Effects of spinal anaesthesia versus epidural anaesthesia for ceasarean section on postoperative analgesic consumption and postoperative pain. Eur J Anaesthesiol. 2009;26:52-9.
45. Mhyre JM, Grennfield ML. A systematic review of randomized controlled trials that evaluate strategies to avoid epidural vein cannulation during obstetric epidural catheter placement. Anesth Analg. 2009;108:1232-42.
46. Bjørnestad E, Rosseland LA. Anaesthesia for Caesarean section. Tidsskr Nor Laegeforen. 2010;130: 748-51.
47. Hong JY, Jee YS, Jeong HJ, Song Y, Kil HK. Effects of epidural fentanyl on speed and quality of block for emergency cesarean section in extending continuous epidural labor analgesia using ropivacaine and fentanyl. Journal of Corean Medical Sciencies. 2010;25:287-92.
48. Huang CJ, Fan YC. Differential impacts of modes of anaesthesia on the risk of stroke among preeclamptic women who undergo Caesarean delivery: a population-based study. Br J Anaesth. 2010;105:818-26.
49. Jeon YT, Hwang JW, Kim MH, Oh AY, Park KH, Park HP. Positional blood pressure change and the risk of hypotension during spinal anesthesia for cesarean delivery: an observational study. Anesth Analg. 2010;111: 712-5.
50. Mancuso A, de Vivo A, Giacobbe A, Priola V, Savasta LM. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. J Matern Fetal Neonatal Med. 2010;23:1114-8.
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