Key result
Previous epidural catheterization significantly increased the risk of epidural anesthesia failure during cesarean section (OR 2.61) compared to patients with no history of catheterization.
Why the study?
Epidural anesthesia failure requires sedation or conversion to general anesthesia, which may be hazardous due to potentially difficult airways, warranting determination of associated risk factors.
Cohort (n=534)
No
Previous epidural catheterization, younger age, and inadequate waiting time significantly increase the risk of epidural anesthesia failure during cesarean section.
Answers are grounded in this paper and cite their sources.
May inform preoperative risk stratification for cesarean EA; leaves open whether targeted interventions reduce failure rates.
BACKGROUND: Epidural anesthesia (EA) is the regional anesthesia technique preferred over spinal anesthesia for pregnant women requiring cesarean section and post-operative pain control. EA failure requires additional sedation or conversion to general anesthesia (GA). This may be hazardous during sedation or GA conversion because of potentially difficult airways. Therefore, this retrospective study aimed to determine the risk factors for epidural failure during cesarean section anesthesia. METHODS: We retrospectively analyzed parturients who underwent cesarean section under EA and catheterization at the Chang Gung Memorial Hospital in Taiwan between January 1 and December 31, 2018. Patient data were collected from the medical records. EA failure was defined as the administration of any intravenous anesthetic at any time during a cesarean section, converting it into GA. RESULTS: A total of 534 parturients who underwent cesarean section were recruited for this study. Of them, 94 (17.6%) experienced EA failure during cesarean section. Compared to the patients with successful EA, those with EA failure were younger (33.0 years vs. 34.7 years), had received EA previously (60.6% vs. 37%), were parous (72.3% vs. 55%), and had a shorter waiting time (14.9 min vs. 16.5 min) (p < 0.05). Younger age (OR 0.91, 95% CI 0.86-0.95), history of epidural analgesia (OR 2.61, 95% CI 1.38-4.94), and shorter waiting time (OR 0.91, 95% CI 0.87-0.97) were estimated to be significantly associated with a higher risk of epidural anesthesia failure. CONCLUSION: The retrospective study found that parturients of younger age, previous epidural catheterization history, and inadequate waiting time may have a higher risk of EA failure. Previous epidural catheterization increased the risk of EA failure by 2.6-fold compared to patient with no history of catheterization.
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Chao et al. (2023) conducted a cohort in Cesarean section requiring epidural anesthesia (n=534). Previous epidural analgesia vs. No previous epidural analgesia was evaluated on Epidural anesthesia failure (administration of any intravenous anesthetic during cesarean section) (OR 2.61, 95% CI 1.38-4.94, p=0.003). Previous epidural catheterization significantly increased the risk of epidural anesthesia failure during cesarean section (OR 2.61) compared to patients with no history of catheterization.
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