Neuraxial anesthesia and postoperative opioid administration for cesarean delivery in patients with placenta accreta spectrum disorder: a retrospective cohort study
| Autor: | A. Wendling, G.D. Panjeton, D. Saleem, R. Samra, Y. Mehkri, P.S. Reynolds |
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| Rok vydání: | 2022 |
| Předmět: |
Placenta accreta
medicine.medical_treatment Analgesic Placenta Accreta Anesthesia General Hysterectomy Pregnancy medicine Humans Retrospective Studies Respiratory distress Cesarean Section business.industry Infant Newborn Obstetrics and Gynecology Retrospective cohort study medicine.disease Analgesics Opioid Anesthesiology and Pain Medicine Opioid Anesthesia Relative risk Anesthetic Female business medicine.drug |
| Zdroj: | International Journal of Obstetric Anesthesia. 49:103220 |
| ISSN: | 0959-289X |
| DOI: | 10.1016/j.ijoa.2021.103220 |
| Popis: | Background There is no consensus on optimal anesthetic and analgesic management of patients presenting for cesarean delivery with suspected placenta accreta spectrum disorder. Neuraxial anesthesia is preferred for uncomplicated procedures, but general anesthesia may be indicated for those at risk of hemorrhage and hysterectomy. We compared the effect of anesthesia techniques on postoperative maternal opioid administration and neonatal respiratory distress. Methods A single-center retrospective study from 2016 to 2019 using electronic records to identify singleton pregnancies with a high index of suspicion of placenta accreta spectrum disorder. Patients were categorized by the anesthetic technique they received: general, neuraxial, or neuraxial with conversion to general anesthesia following delivery. Postoperative maternal opioid administration (oral morphine in mg equivalents) and risk of neonatal respiratory distress were compared using linear mixed models. Results Thirty-nine records were analyzed. Mean-adjusted oral morphine mg equivalents were 192 for patients receiving general anesthesia vs. 90 for neuraxial anesthesia only (P=0.009) and 104 for neuraxial with conversion to general anesthesia (P=0.052). Neonates delivered under general anesthesia had a 3.5 times relative risk (95% CI 1.3 to 9.8, P=0.017) of respiratory distress compared with those exposed to neuraxial anesthesia alone. Conclusion Patients receiving general anesthesia alone were administered more opioids than those undergoing neuraxial anesthesia or neuraxial with conversion to general anesthesia. This finding was maintained when accounting for whether or not the patient underwent hysterectomy. Deciding on anesthetic management requires consideration of patient comorbidities, severity of placenta accreta spectrum pathology, and surgical requirements. |
| Databáze: | OpenAIRE |
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