A retrospective analysis of maternal complications and newborn outcomes of general anesthesia for cesarean delivery in a single tertiary hospital in China

Yang Bao; Ting Zhang; Ling Li; Changqing Zhou; Minxian Liang; Jie Zhou; Chunling Wang

doi:10.1186/s12871-022-01753-y

A retrospective analysis of maternal complications and newborn outcomes of general anesthesia for cesarean delivery in a single tertiary hospital in China

BMC Anesthesiol. 2022 Jul 6;22(1):208. doi: 10.1186/s12871-022-01753-y.

Authors

Yang Bao^#¹, Ting Zhang^#¹, Ling Li¹, Changqing Zhou¹, Minxian Liang², Jie Zhou³, Chunling Wang⁴

Affiliations

¹ Department of Anesthesiology, Qilu Hospital of Shangdong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, China.
² Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
³ UMass Memorial Hospital University of Massachusetts Chan Medical School, 119 Belmont St, Worcester, MA, 01605, USA.
⁴ Department of Anesthesiology, Qilu Hospital of Shangdong University, 107 Wenhua Xi Road, Jinan, 250012, Shandong, China. wchl2000@163.com.

^# Contributed equally.

Abstract

Background: Either neuraxial anesthesia or general anesthesia can be performed for cesarean delivery. Generally, neuraxial anesthesia is the first choice with the risk and benefit balance for both the mother and fetus. However, general anesthesia is also applicable most commonly in the emergent setting. This study analyzed maternal complications associated with general anesthesia for cesarean delivery and suggested lowering pregnancy-related maternal and newborn adverse outcomes.

Methods: With the approval of the Institutional Ethics Review Board (No: 2017016), data on cesarean delivery and related anesthesia were collected from the Electronic Health Record System from 1/1/2013 to 12/31/2016. Statistical software STATA version 15.1 was used for data analyses. All statistical tests were two-sided, and a level significance of 0.05 was assumed.

Results: The rate of general anesthesia for cesarean delivery increased steadily during 2013-2016, 3.71% in 2013 to 10.23% in 2016 (p < 0.001). Repeat cesarean delivery among general anesthesia group increased significantly from 16.22% in 2013 to 54.14% in 2016 (p < 0.001). Morbidly adherent placenta (MAP) was the first reason among pregnancy-related complications, which accounted for 33% in total in general anesthesia group (38% in 2013 to 44% in 2016). The laryngeal mask airway (LMA) was used in airway management, and the proportion of LMA increased from 28.38% in 2013 to 92.99% in 2016 (p < 0.001). There were significant differences in newborn outcomes between general anesthesia and neuraxial anesthesia groups, including newborn weight, newborn Apgar score at 1 min and 5 min and newborn admission to the NICU (p < 0.001).

Conclusions: The growing incidence of general anesthesia was consistent with the trend of rising repeat cesarean delivery and MAP. low newborn Apgar score and high newborn admission to the NICU in general anesthesia group compared with neuraxial anesthesia group. The LMA was performed safely for airway management with enough fasting and careful gastric volume evaluation.

Keywords: Cesarean delivery; General anesthesia; Morbidly adherent placenta; Neuraxial anesthesia.

MeSH terms

Anesthesia, General / adverse effects
Cesarean Section / adverse effects
Female
Humans
Infant, Newborn
Laryngeal Masks*
Pregnancy
Pregnancy Complications*
Retrospective Studies
Tertiary Care Centers