Key result
General anaesthesia is linked to ~10-13 minutes shorter decision-to-delivery intervals for emergency C-sections versus spinal or epidural.
Why the study?
Does the choice of anaesthetic technique or work shift impact the Decision to Delivery Interval in emergency caesarean sections?
Observational (n=135)
No
Does the choice of anaesthetic technique or work shift impact the Decision to Delivery Interval in emergency caesarean sections?
General anaesthesia shortens the decision to delivery interval for emergency caesarean sections compared to regional techniques, though regional techniques still maintain a short interval and are associated with better 5-minute Apgar scores.
Answers are grounded in this paper and cite their sources.
GA was associated with shorter DDI; leaves open optimal technique balancing speed versus neonatal outcomes in emergency caesarean sections.
<ns4:p> <ns4:bold>Background:</ns4:bold> One important task of the emergency anaesthesia service is to provide rapid, safe and effective anaesthesia for emergency caesarean sections (ECS). A Decision to Delivery Interval (DDI) <30 minutes for ECS is a quality indicator for this service. The aim of this study was to assess the DDI and the impact of chosen anaesthetic technique (general anaesthesia (GA), spinal anaesthesia (SPA) with opioid supplementation, or “top-up” of labour epidural analgesia (tEDA) with local anaesthesia and fentanyl mixture) and work shift for ECS at Danderyds Hospital, Sweden. </ns4:p> <ns4:p> <ns4:bold>Methods:</ns4:bold> A retrospective chart review of ECS at Danderyds Hospital was performed between January and October 2016. Time between decision for CS, start of anaesthesia, time for incision and delivery, type of anaesthetic technique, and time of day, working hours or on call and day of week, Monday – Friday, and weekend was compiled and analysed. Time events are presented as mean ± standard deviation. Non-parametric tests were used. </ns4:p> <ns4:p> <ns4:bold>Results:</ns4:bold> In total, 135 ECS were analysed: 92% of the cases were delivered within 30 minutes and mean DDI for all cases was 17.3±8.1 minutes. GA shortened the DDI by 10 and 13 minutes compared to SPA and tEDA (p<0.0005). DDI for SPA and tEDA did not differ. There was no difference in DDI regarding time of day or weekday. Apgar <7 at 5’ was more commonly seen in ECS having GA (11 out of 64) compared to SPA (2/30) and tEDA (1/41) (p<0.05). </ns4:p> <ns4:p> <ns4:bold>Conclusion:</ns4:bold> GA shortens the DDI for ECS, but the use of SPA as well as tEDA with opioid supplementation maintains a short DDI and should be considered when time allows. Top-up epidural did not prolong the DDI compared to SPA. The day of week or time of ECS had no influence on the anaesthesia service as measured by the DDI. </ns4:p>
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Hein et al. (2017) conducted an observational in Emergency caesarean sections (n=135). General anaesthesia vs. Spinal anaesthesia or top-up of labour epidural analgesia was evaluated on Decision to Delivery Interval (DDI) (10 and 13 minutes reduction, p=<0.0005). General anaesthesia shortened the Decision to Delivery Interval for emergency caesarean sections by 10 and 13 minutes compared to spinal anaesthesia and top-up epidural analgesia.
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