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Obstetric Anesthesia Complications Database Is Established


 

From the annual meeting of the Society for Obstetric Anesthesiology and Perinatology

Major Finding: High spinal block occurred with 1 of every 4,300 regional anesthetics. Other anesthesia-related serious complications were far less common, including respiratory distress during labor and delivery in 1 in 10,000, unrecognized spinal catheter in 1 in 15,000, and severe neurologic injury in 1 in 36,000.

Data Source: The Society for Obstetric Anesthesia and Perinatology Serious Complication Repository.

Disclosures: None was reported.

SAN ANTONIO — Serious obstetric complications occur in approximately 1 in 1,900 deliveries and serious anesthesia-related complications in about 1 in 3,000, according to data from a large multisite repository.

The Society for Obstetric Anesthesia and Perinatology Serious Complication Repository (SOAP SCORE) project was established in 2004 with the aim of gathering accurate data on the incidence of both overall obstetric- and obstetric anesthesia–related complications, as well as additional information about the complications that could inform future obstetric anesthesia practice.

Until now, complication rates reported in the literature have varied dramatically. “From this database, we can tell you that the rate of serious anesthesia-related obstetric complications is very low,” said Dr. Robert D'Angelo, professor of anesthesiology at Wake Forest University, Winston-Salem, N.C.

Data were collected on a quarterly basis from 25 institutions between Oct. 1, 2004, and June 30, 2009. Of a total 307,500 deliveries, approximately 257,000 (84%) involved anesthesia and 96,000 were cesarean sections. Regional anesthesia was used in about 76% of the vaginal deliveries and in 69% of the C-sections. There were a total of 158 serious complications, for a rate of 1 in 1,900 deliveries. Of those, 84 were deemed to be related to anesthesia, for a rate of 1 in 3,000. Failed regional anesthesia occurred in 1.7%.

Failed intubation occurred with 1 of every 533 general anesthetics, and high spinal block in 1 of every 4,300 regional anesthetics. Other anesthesia-related serious complications were far less common, including respiratory distress during labor and delivery in 1 in 10,000, unrecognized spinal catheter in 1 in 15,000, and severe neurologic injury in 1 in 36,000. The rate of epidural abscess/meningitis related to anesthesia was 1 in 63,000, while the rates of anesthesia-related myocardial infarction and cardiac arrest were both just 1 in 128,000. Rarest of all was epidural hematoma, in 1 in 250,000.

There were 30 maternal deaths and 5 cases of anaphylaxis, but none was deemed to be anesthesia related. There were no aspirations, Dr. D'Angelo said.

High spinal block was the only anesthesia-related complication reported in large enough numbers to allow for generalizations regarding associated risk factors. Of the 58 high spinal blocks reported, 14 were the result of an unrecognized spinal catheter. Of the remaining 44, known risk factors were identified in 32. The most common of these were obesity and spinal anesthesia following failed epidural.

Data were also collected on postdural puncture headaches (PDPH). Of the 1,647 reported PDPH, 917 (56%) were treated with epidural blood patch, and 98 (11% of EBP) required a repeat blood patch.

In October 2008, the American Society of Anesthesiologists formed the Anesthesia Quality Institute (www.aqihq.org

They plan to publish their first set of findings by January 2011, Dr. D'Angelo said in an interview.

'The rate of serious anesthesia-related obstetric complications is very low.'

Source DR. D'ANGELO

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