Jean Guglielminotti, M.D., Ph.D.; Ruth Landau, M.D.; Guohua Li, M.D., Dr.PH
Anesthesiology 6 2019, Vol.130, 912-922
Use of general anesthesia for cesarean delivery has consequently markedly decreased during the last decade.This decrease was associated with a parallel decrease in anesthesia-related morbidity. The current general anesthesia rate for cesarean delivery is estimated around 5.5%.Further reduction in this rate could be a potential area for clinical interventions to improve the safety and quality of obstetric anesthesia care and reduce anesthesia-related morbidity. However, use of general anesthesia for cesarean delivery may be clinically indicated in women with specific preexisting or pregnancy-associated conditions (e.g., severe heart valve stenosis), in high-risk obstetrical situations (e.g., morbidly adherent placenta), or in women with contraindications to neuraxial techniques (e.g., coagulation factor deficit). In these situations, the risk–benefit balance may favor general anesthesia, and the additional risk associated with general anesthesia compared with neuraxial anesthesia can be deemed acceptable. On the contrary, additional risks associated with general anesthesia without a clinical condition precluding use of neuraxial anesthesia could be deemed as unnecessary because exposure to general anesthesia-associated risks is avoidable. To date, most of the research on general anesthesia for cesarean delivery has examined general anesthesia as a whole without individualizing situations in which general anesthesia was not clinically indicated. Characterizing patient- and hospital-level factors associated with general anesthesia without a recorded clinical indication or characterizing groups of patients and hospitals with potentially avoidable use of general anesthesia use could help identify targets for quality assurance programs.
