The use of adjunct anesthetic medication with regional anesthesia and rates of general anesthesia for 1867 cesarean deliveries from 2014 to 2018 in a community hospital

Abstract

The number of cesarean deliveries performed with a general anesthetic decreased when regional anesthesia for cesarean delivery was reported to be associated with lower maternal mortality. Anesthetic adjunct administration for cesarean deliveries performed with regional anesthesia is typically not reported alongside general anesthesia rates for cesarean delivery. This retrospective study analyzed rates of general anesthesia and systemic anesthetic adjunct administration for cesarean deliveries performed under regional anesthesia at a community hospital from 2014 to 2018. We used the hospital electronic medical record system to collect data on cesarean deliveries during the study period. A total of 1867 cesarean deliveries were performed, corresponding to a cesarean delivery rate of 30.4%. Of the subjects, 104 (5.6%) received general anesthesia and 333 (17.8%) received regional anesthesia with at least one systemic anesthetic adjunct. These adjuncts included a variety of intravenous agents—midazolam (1.7%), fentanyl (5.2%), morphine (6.6%), propofol (7.9%), and ketamine (1.7%)—as well as inhaled nitrous oxide (1.4%) and sevoflurane (0.1%). These data on anesthetic adjunct administration with regional anesthesia provide clinical context for the rates of general anesthesia reported for cesarean delivery.

Keywords:

• Analgesia
• cesarean section
• conversion to general anesthesia
• regional anesthesia
• obstetric anesthesia

ACKNOWLEDGMENTS

The authors acknowledge Courtney Shaver, MS, for help in biostatistical analysis. This study was departmentally funded.