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C-SECTION – WHEN REGIONAL IS NOT AN OPTION!
ESRA Academy. Lima G. Sep 8, 2016; 138624; 0510 Topic: GENERAL PRINCIPLES OF REGIONAL ANAESTHESIA (RA)
Gisela Lima
Gisela Lima

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Abstract
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Background and Aims:

The Royal College of Anaesthetics suggests fewer than 15% of emergency and fewer than 5% of elective c-section should be performed under general anaesthesia(GA). In Portugal, however, the percentage of c-sections and GA remain high. Regional anaesthesia(RA) is the hallmark for a c-section. However, when there are contraindications(CI) to RA, urgency or inadequate regional block, GA is indicated.
We pretend characterize the reasons why RA was not performed in the group that underwent GA for c-section at our unit from January 2010 to December 2015. 

Methods:

Retrospective observational study based on medical records for this period.

Results:

There were 4471 c-sections(28,9% from 15438 childbirths). The main reason was non reassuring foetal status followed by stalled labour and foeto-pelvic incompatibility.RA was performed in 86,7%: 78,6% to epidural blockade, followed by spinal anaesthesia, isolated(7,5%) or in a sequential technique(13,9%).GA was mainly for emergent foetal extractions(43,6%) or maternal CI for neuroaxial technique(29,0%). Failed RA(16,3%) and maternal refusal(5,5%) were other causes. Foetal heart decelerations(50,5%), placental abruption(17,5%), severe pre-eclampsy and HELLP(15,25%) were the most frequent emergencies. Spine pathology(25,3%), coagulation disorders(22,3%) and other chronic diseases(23,1%) were maternal CI to RA.The percentage of c-section(27,5 to 28,9%) remained stable over time. GA has shown a slight decrease(12,6% in 2015 vs 14,8% in 2010).

Conclusions:

Although decreasing, we still observe a high rate of GA for c-section. As a referral centre, the high prevalence of maternal disorders and pathologic pregnancies, can contribute. As a teaching anaesthesia unit, the prevalence of a regional failed technique is probably inflated.

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