Original scientific paper
https://doi.org/10.20471/acc.2022.61.s2.02
Conversion Rate of Epidural Analgesia to Caesarean Section Regional or General Anesthesia
Ivan Šklebar
orcid.org/0000-0002-4557-7626
; Clinical Department of Anaesthesiology, Reanimatology and Intensive Care, “Sveti Duh” University Hospital, Zagreb, Croatia; School of Medicine Catholic University of Croatia, Zagreb, Croatia; Bjelovar University of Applied Sciences, Bjelovar, Croatia
Marija Vrljičak
; Clinical Department of Anaesthesiology, Reanimatology and Intensive Care, “Sveti Duh” University Hospital, Zagreb, Croatia
Dubravko Habek
; School of Medicine Catholic University of Croatia, Zagreb, Croatia; Clinical Department of Obstetrics and Gynaecology, “Sveti Duh” University Hospital, Zagreb, Croatia
Tomislav Šklebar
; Bjelovar University of Applied Sciences, Bjelovar, Croatia; Department of Surgery, Dr Tomislav Bardek General Hospital, Koprivnica, Croatia
Livija Šakić
; Clinical Department of Anaesthesiology, Reanimatology and Intensive Care, “Sveti Duh” University Hospital, Zagreb, Croatia; Faculty of Dental Medicine and Health Josip Juraj Strossmayer, University of Osijek, Osijek, Croatia
Abstract
Introduction: Epidural analgesia is acknowledged as the most common method
of analgesia during labor. If emergent Caesarean section (CS) is indicated in parturient with existing
labor epidural, the need for conversion from epidural analgesia to regional (RA) or general anesthesia
(GA) increases accordingly. Recent guidelines suggest the rate of conversion to general anesthesia
shows the quality of obstetric anesthesia care and should be under 5%.
The aim: The aim of this study is to determine the conversion rate from epidural analgesia to Caesarean
section anesthesia in “Sveti Duh” University Hospital Zagreb in order to enhance the quality
of anesthetic care for obstetric patients.
Methods: We retrospectively included in the study all parturients who received epidural labor analgesia
but needed subsequent regional or general anesthesia for Caesarean section in our institution
for the period of 1st January 2021 to 31st December 2021. After the data analysis on the conversion
rate from epidural analgesia to Caesarean section anesthesia had been performed, we compared our
data to current standards and relevant literature findings.
Results: Altogether 1202 epidural catheters were placed for labor analgesia in the study period,
and in 199 of these cases, the emergent Caesarean section was indicated. Epidural analgesia was converted
to epidural anesthesia (EA) in 153 (76,9%) parturients, to general anesthesia in 40 (20,1%), and
to spinal anesthesia (SA) in six (3%) parturients. After comparison with recommended quality standards
and with the results of similar studies by other authors, our findings show a significantly higher
rate of conversion from epidural analgesia to general anesthesia than has been desirable since then.
Conclusion: In order to reach the required quality standards regarding the conversion rate from
epidural analgesia to Caesarean section anesthesia, it is necessary to improve the organization of the
work of the obstetric anesthesiology team according to the principle of subspecialization. It is imperative
to implement the best clinical practice protocols for obstetric anesthesiologists, but also to
enhance the communication and coordination with the obstetric team.
Keywords
Epidural analgesia; Caesarean section anesthesia; Conversion from epidural analgesia to anesthesia; Quality standards of obstetric anesthesia
Hrčak ID:
284279
URI
Publication date:
1.9.2022.
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