GENERAL-ANESTHESIA FOR CESAREAN-SECTION AT A TERTIARY CARE HOSPITAL 1990-1995 - INDICATIONS AND IMPLICATIONS

Complications of general anesthesia for cesarean section remain the le ading cause of anesthesia-related maternal mortality. General anesthes ia, however, is becoming less popular for obstetric anesthesia, and th us fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult i ntubations witnessed and managed by residents decreases. In addition, patients who undergo general anesthesia may have co-morbidities which, while not contraindicating regional anesthesia, may increase the risk of providing anesthesia. We reviewed the medical records of 6 calenda r years (1990-1995) at our busy tertiary center: to determine patient demographics, indications for cesarean section, indications for genera l anesthesia, time of day, and complications related to airway managem ent. From 1990 through 1995, cesarean sections under general anesthesi a decreased from 7.2% to 3.6% (P = 0.0001), however, they were perform ed on parturients with more maternal diseases (17.2% to 35.8%; P = 0.0 034). Although the incidence of difficult intubations in those years r anged from 16.3% to 1.3%, only one failed intubation with resultant ma ternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway m anagement programs specifically for the obstetric population may assis t efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section.