产后输卵管结扎麻醉管理的回顾性队列研究

IF 2.6 3区 医学 Q2 ANESTHESIOLOGY
J. Ansari , M. Sheikh , E. Riley , N. Guo , A. Traynor , B. Carvalho
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引用次数: 0

摘要

背景产后输卵管结扎术(PPTL)通常采用重新激活分娩硬膜外导管的经脉麻醉,但最佳麻醉方法尚不清楚。我们评估了产后输卵管结扎术(PPTL)的麻醉方法,并评估了产程硬膜外导管再激活、重新脊髓麻醉和阻滞失败后脊髓麻醉的失败率。方法 我们对连续接受 PPTL 的 300 名患者和因剖宫产而接受脊髓麻醉的 100 名患者进行了单中心回顾性队列分析。我们从电子病历中收集了麻醉管理数据(现有分娩硬膜外导管重新启用、重新进行脊髓麻醉或全身麻醉)。结果 硬膜外导管重新激活或脊髓麻醉失败后,失败率分别为15%和23%。硬膜外导管重新启动失败率为 35%。剖宫产脊髓麻醉失败率为 4%。药物剂量、产程中硬膜外导管的使用、硬膜外导管置入或分娩后的时间、产程中的神经麻醉技术(脊髓-硬膜外联合麻醉、硬膜外麻醉)、产程中的补充剂量以及麻醉师的经验都不能预测神经麻醉的失败。这一结果与其他机构最近的研究结果一致,并且高于与剖宫产相关的脊髓麻醉失败率。需要进一步研究以确定最佳麻醉剂量策略,并了解 PPTL 神经麻醉失败率高的背后机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A retrospective cohort study of the anesthetic management of postpartum tubal ligation

Background

Neuraxial anesthesia with reactivation of a labor epidural catheter is commonly utilized for postpartum tubal ligations (PPTL), although the optimal anesthetic approach is unknown. We assessed institutional anesthesia practices for PPTL, and evaluated the failure rates of reactivation of labor epidural catheters, de novo spinal anesthesia, and spinal anesthesia after failed blocks.

Methods

We conducted a single-center retrospective cohort analysis of 300 consecutive patients who underwent a PPTL and 100 having spinal anesthesia for cesarean delivery. Anesthetic management data (existing labor epidural catheter reactivation, de novo spinal anesthesia or general anesthesia) were collected from electronic medical records. Anesthetic block failure rates were determined for each anesthetic technique.

Results

The failure rate was 15% for de novo spinal anesthesia and 23% after failed reactivation of a labor epidural catheter or spinal anesthesia. The epidural catheter reactivation failure rate was 35%. The failure rate of spinal anesthesia for cesarean delivery was 4%. Drug dosage, epidural catheter use in labor, time since epidural catheter placement or delivery, labor neuraxial technique (combined spinal-epidural, epidural), supplemental top-up doses during labor, and anesthesiologist experience did not predict neuraxial anesthesia failures.

Conclusions

Our analysis revealed an unexpectedly high neuraxial anesthesia failure rate even when de novo spinal anesthesia was used for PPTL. The results are consistent with other institutions' recent findings, and are higher than spinal anesthesia failure rates associated with cesarean delivery. Further studies are required to determine optimal anesthesia dosing strategies, and to understand the mechanisms behind high neuraxial anesthesia failures for PPTL.

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来源期刊
CiteScore
4.70
自引率
7.10%
发文量
285
审稿时长
58 days
期刊介绍: The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.
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