Incidence and risk factors for maternal hypoxaemia during induction of general anaesthesia for non-elective Caesarean section: a prospective multicentre study. (July 2020)

• Record Type: Journal Article
• Authors: Bonnet, Marie-Pierre; Mercier, Frédéric J.; Vicaut, Eric; Galand, Anne; Keita, Hawa; Baillard, Christophe
• Is Part Of: British journal of anaesthesia. Volume 125:Number 1(2020)
• Page Start: e81
• Page End: e87
• Publication Date: 2020-07
• Subjects: airway management -- Caesarean section -- difficult intubation -- general anaesthesia -- hypoxaemia -- pregnancy -- propofol -- tracheal intubation; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2020.03.010
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: Pregnant women are at increased risk of hypoxaemia during general anaesthesia. Our aim was to determine the incidence and the risk factors that contribute to hypoxaemia in this setting. Methods: Every woman 18 yr or older who underwent a non-elective Caesarean section under general anaesthesia was eligible to participate in this multicentre observational study. The primary endpoint was the incidence of hypoxaemia defined as the SpO2 ≤95%. The secondary endpoint was the incidence of difficult intubation defined as more than two attempts or failed intubation. Results: During the study period, 895 women were prospectively included in 17 maternity hospitals, accounting for 79% of women who had general anaesthesia for non-elective Caesarean section. Maternal hypoxaemia was observed in 172 women (19%; confidence interval [CI], 17–22%). Risk factors associated with hypoxaemia in the multivariate analysis were difficult or failed intubation (adjusted odds ratio [aOR]=19.1 [8.6–42.7], P <0.0001) and BMI >35 kg m −2 (aOR=0.53 [0.28–0.998], P =0.0495). Intubation was difficult in 40 women (4.5%; CI, 3.3–6%) and failed intubation occurred in five women (0.56%; CI, 0.1–1%). In the multivariate analysis, use of a hypnotic drug other than propofol was associated with difficult or failed intubation (aOR=25 [2–391], P =0.02). A propensity score confirmed that propofol was associated with a significant decreased risk of difficulty or failure to intubate ( P <0.001). Conclusions: Hypoxaemia during Caesarean sections was observed in 19% of women and was significantly associated with difficult or failed intubation. The use of propofol may protect against the occurrence of difficult intubation.