Type, management, and associated factors of failed spinal anesthesia in cesarean section. Prospective cohort study

Abstract

Background

Spinal anesthesia is an anesthesia technique suitable for cesarean section to avoid respiratory complications. However, the management of spinal anesthesia is very important because spinal anesthesia may fail and the patient may be exposed to pain and discomfort.

Objective

To assess the type, management, and related factors of failure of spinal anesthesia at cesarean section.

Methods

Multicenter prospective cohort study was conducted at a public hospital in Addis Ababa on 794 mothers who met the criteria for cesarean section under spinal anesthesia. Data collection methods were adopted, including chart reviews and observations of spinal anesthesia procedures. The data collected was entered in Epi info version 7 and analyzed in SPSS version 20. Independent variables with dependent variables were analyzed using logistic regression. A p-value of 0.05 for & it; was considered a statistically significant test cutoff.

Result

Of 121 failed spinal anesthesia 35 were complete and 86 were partial failed spinal anesthesia from those complete failed spinal anesthesia were managed by repeating spinal and converting to general anesthesia and partial failed spinal anesthesia were managed by the supplementary drug. Experience of the anesthetist <1 (AOR = 4.12, 95% CI, 2.47–6.90), patient position (AOR = 14.43,95%CL, 2.65–78.61), number of attempts>1 (AOR = 9.26, 95% CI, 5.69–15.01), bloody CSF (AOR = 6.37, 95%CI, 2.90–13.96), BMI ≥30kgm2 (AOR = 2.03, 95%CI, 1.12–3.68) and dose of bupivacaine <10 mg (AOR = 2.72, 95% CI, 1.33–5.53) were found to be statistically significant associated with failed spinal anesthesia.

Conclusion and recommendation

Experience of anesthetists (<1 year), obesity, bupivacaine dose <10 mg, bloody appearance of CSF, number of attempts> 1 were associated factors for failed spinal anesthesia in cesarean section. Our failed spinal management is not the same among hospitals and does not follow recommended failed spinal management. Up-skilling of anesthesia professionals should be considered on identified associated factors of failed spinal anesthesia and management of failed spinal anesthesia should be based on the recommended guidelines.

Highlights

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  Failed spinal anesthesia may lead to maternal discomfort.

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  In our study failed spinal managements were not along with recommended guidelines.

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  Experience of the anesthetist, bloody CSF others were associated factors for FSA.