CONVERSION RATE OF EPIDURAL ANALGESIA TO CAESAREAN SECTION REGIONAL OR GENERAL ANESTHESIA

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Public Health

Background:

• Epidural analgesia is standard for labor pain management.
• Emergent Cesarean sections (CS) may necessitate conversion to regional (RA) or general anesthesia (GA).
• Guidelines recommend GA conversion rates below 5% as an indicator of obstetric anesthesia quality.

Purpose of the Study:

• To determine the conversion rate from labor epidural analgesia to CS anesthesia at a university hospital.
• To evaluate the quality of obstetric anesthesia care based on conversion rates.
• To identify areas for improvement in anesthetic management during emergent Cesarean births.

Main Methods:

• Retrospective analysis of parturients receiving epidural labor analgesia between January 1, 2021, and December 31, 2021.
• Inclusion of cases requiring conversion to regional or general anesthesia for Cesarean section.
• Comparison of observed conversion rates with established quality standards and literature.

Main Results:

• Out of 1202 epidural placements, 199 cases required emergent Cesarean sections.
• Conversion to epidural anesthesia (EA) occurred in 76.9%, general anesthesia (GA) in 20.1%, and spinal anesthesia (SA) in 3%.
• The rate of conversion to GA (20.1%) significantly exceeded the recommended quality standard of <5%.

Conclusions:

• The current conversion rate to general anesthesia for Cesarean sections is unacceptably high.
• Improving obstetric anesthesia quality necessitates subspecialization within the anesthesiology team.
• Enhanced communication and coordination between anesthesiology and obstetrics teams are crucial for meeting quality standards.