Key result
Factors significantly associated with the choice of general anesthesia over regional anesthesia included higher ASA physical status (OR 2.7), presentation with bleeding (OR 1.8), and heart rate >125 bpm (OR 5.6).
Why the study?
What factors are associated with the choice of general versus regional anesthesia in parturients with placenta previa undergoing cesarean delivery?
Cohort (n=562)
No
What factors are associated with the choice of general versus regional anesthesia in parturients with placenta previa undergoing cesarean delivery?
Odds Ratio: 2.7 (95% CI 1.7–4.3)
p-value: p=<0.001
Regional anesthesia is the most commonly used and safe technique for cesarean delivery in placenta previa, while general anesthesia is more frequently chosen for patients with higher ASA physical status, active bleeding, anterior placenta, and intraoperative tachycardia.
These associations should not yet guide anesthesia choice in placenta previa; leaves open need for prospective outcome trials.
Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P < 0.05 was considered significant. Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P < 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate >125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P < 0.001. Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.
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Charoenraj et al. (2014) conducted a cohort in Placenta previa requiring cesarean delivery (n=562). General anesthesia vs. Regional anesthesia was evaluated on Choice of general anesthesia associated with higher ASA physical status (OR 2.7, 95% CI 1.7-4.3, p=<0.001). Factors significantly associated with the choice of general anesthesia over regional anesthesia included higher ASA physical status (OR 2.7), presentation with bleeding (OR 1.8), and heart rate >125 bpm (OR 5.6).
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