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Conversion of epidural labour analgesia to anaesthesia for Caesarean section: a prospective study of the incidence and determinants of failure - 10/2/2009

Br J Anaesth 2009; 102: 240-3


The incidence of general anaesthesia (GA) has been used as a marker for the quality of obstetric anaesthesia care. Recent guidelines suggest that the rate of GA for Caesarean section in parturients with pre-existing epidural analgesia for labour should be <3%. The main aim of this study was to establish whether or not this standard is achievable in a university teaching hospital. The authors also aimed to determine the factors influencing the incidence of inadequate anaesthesia.


The authors studied a consecutive cohort of 501 patients who had a Caesarean section after epidural labour analgesia, and recorded the incidence of GA, the total incidence of failure and the factors previously associated with failure. Factors shown to be significant with univariate analysis were used in a binary logistic regression to determine the independent risk factors for failure.


Twenty-one of 501 parturients required GA (4.1%, 95% confidence interval [CI] 2.6-6.3%), not significantly different from 3% (p=0.1). Fifteen of 21 (71%) of these occurred intraoperatively. The total failure rate was 30/501 (5.9%, 95% CI 4.0-8.4%). Maternal height and the number of clinician top-ups in labour were significant independent risk factors for failure.


The authors conclude that intraoperative conversion to GA can increase both maternal and fetal risks. Strategies to reduce the incidence may include early recognition of inadequate labour analgesia and reliable assessment of adequacy of surgical anaesthesia.

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