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Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review
Anaesthesia ( IF 7.5 ) Pub Date : 2022-01-22 , DOI: 10.1111/anae.15657
R Patel 1 , J Kua 1 , N Sharawi 2 , M E Bauer 3 , L Blake 4 , S R Moonesinghe 5 , P Sultan 6
Affiliation  

Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neuraxial anaesthesia; and the effect of mode of anaesthesia. We searched studies reporting inadequate neuraxial anaesthesia that used ≥ ED95 doses (effective dose in 95% of the population) of neuraxial local anaesthetic agents. Our primary outcome was the prevalence of inadequate neuraxial anaesthesia, defined as the need to convert to general anaesthesia; the need to repeat or abandon a planned primary neuraxial technique following incision; unplanned administration of intra-operative analgesia (excluding sedatives); or unplanned epidural drug supplementation. Fifty-four randomised controlled trials were included (3497 patients). The overall prevalence of requirement for supplemental analgesia or anaesthesia was 14.6% (95%CI 13.3–15.9%); 510 out of 3497 patients. The prevalence of general anaesthesia conversion was 2 out of 3497 patients (0.06% (95%CI 0.0–0.2%)). Spinal/combined spinal–epidural anaesthesia was associated with a lower overall prevalence of inadequate neuraxial anaesthesia than epidural anaesthesia (10.2% (95%CI 9.0–11.4%), 278 out of 2732 patients vs. 30.3% (95%CI 26.5–34.5%), 232 out of 765 patients). Further studies are needed to identify risk factors, optimise detection and management strategies and to determine long-term effects of inadequate neuraxial anaesthesia.

中文翻译:

择期剖腹产患者的椎管内麻醉不充分:一项系统评价

椎管内麻醉广泛用于择期剖腹产手术,但术中麻醉不足的普遍性尚不清楚。我们的目的是确定择期剖宫产术中椎管内麻醉不充分的发生率;在椎管内麻醉不充分后从椎管内麻醉转为全身麻醉的流行率;以及麻醉方式的影响。我们检索了报告椎管内麻醉不充分的研究,这些研究使用了≥ ED95 剂量(95% 的人群有效剂量)的椎管内局部麻醉剂。我们的主要结果是椎管内麻醉不充分的发生率,定义为需要转为全身麻醉;切开后需要重复或放弃计划的主要椎管内技术;计划外的术中镇痛(不包括镇静剂);或计划外的硬膜外药物补充。纳入了 54 项随机对照试验(3497 名患者)。需要补充镇痛或麻醉的总体患病率为 14.6% (95%CI 13.3–15.9%);3497 名患者中的 510 名。在 3497 名患者中,全身麻醉转换的发生率为 2 例 (0.06% (95%CI 0.0–0.2%))。与硬膜外麻醉相比,腰麻/腰硬联合麻醉与椎管内麻醉不充分的总体患病率较低有关 (10.2% (95%CI 9.0–11.4%),2732 名患者中有 278 名 vs. 30.3% (95%CI 26.5–34.5) %), 765 名患者中有 232 名)。需要进一步的研究来确定危险因素,优化检测和管理策略,并确定不充分的椎管内麻醉的长期影响。
更新日期:2022-02-10
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