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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

496
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
496
General Anesthesia: Overview01:24

General Anesthesia: Overview

282
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
282
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

764
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
764
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

195
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
195
Stages of General Anesthesia01:22

Stages of General Anesthesia

673
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
673
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

927
Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
927

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Related Experiment Video

Updated: Sep 8, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Risk factors for labor epidural conversion failure requiring general anesthesia for cesarean delivery.

Shannon M Grap1, Gaurav R Patel1, Jessica Huang1

  • 1Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States.

Journal of Anaesthesiology, Clinical Pharmacology
|June 16, 2022
PubMed
Summary

Epidural conversion failure for Caesarean delivery (CD) occurred in 21% of cases. Younger maternal age and urgent CD were key risk factors for failed epidural anesthesia.

Keywords:
Cesarean deliveryconversion ratesgeneral anesthesialabor epiduralobstetric anesthesia

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Maternal-Fetal Medicine

Background:

  • Labor epidural analgesia is common for laboring patients.
  • Conversion of labor epidurals to general anesthesia for Caesarean delivery (CD) is sometimes necessary.
  • Understanding failure rates and risk factors is crucial for optimizing patient care.

Purpose of the Study:

  • To determine the rate of labor epidural conversion failure requiring general anesthesia for CD.
  • To identify patient-specific and procedural risk factors associated with this failure.

Main Methods:

  • Retrospective review of 673 pregnant patients undergoing conversion from labor epidural to CD.
  • Comparison of successful epidural conversions versus those requiring general anesthesia.
  • Analysis of patient characteristics and intraoperative factors.

Main Results:

  • The overall rate of epidural conversion failure was 21%.
  • Significant risk factors for failure included younger maternal age, intraoperative fentanyl or midazolam supplementation, and more urgent CD categories.
  • Younger age (95% CI 0.94) and IV fentanyl (95% CI 0.19) or midazolam (95% CI 0.26) supplementation were associated with increased failure.

Conclusions:

  • Younger maternal age and urgent CD are associated with higher rates of epidural conversion failure.
  • These findings suggest potential issues with labor epidural effectiveness prior to CD.
  • Further prospective studies are needed, emphasizing diligent evaluation of labor epidural function.