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International Journal of Women's Health Nursing And Practices Original Research

Frequency of Failed Spinal Anesthesia and Associated Factors in Cesarean Section at Mardan Medical Complex, Mardan, KP, Pakistan

  1. Shabir Ahmad Mardan Medical Complex (MTI), Hospital in Mardan
  2. Abdul Qadeer Mardan Medical Complex (MTI), Hospital in Mardan
  3. Roohul Amin Government Girls Post Graduate College
  4. Saeed Anwar Mardan Medical Complex (MTI), Hospital in Mardan
  5. Hamid Ullah Mardan Medical Complex (MTI), Hospital in Mardan
  6. Omama Akmal Mardan Medical Complex (MTI), Hospital in Mardan
  7. Tahir Khan Mardan Medical Complex (MTI), Hospital in Mardan

Abstract

Objective: Spinal anesthesia is the preferred choice of anesthesia for parturients having cesarean sections. Despite the high percentage of success in providing acceptable surgical anesthesia, failure of spinal anesthesia has been reported. This study aims to determine the frequency and associated factors related to failed spinal anesthesia during cesarean sections in pregnant women.

Methodology: This descriptive cross-sectional study included 149 pregnant women and was conducted at Mardan Medical Complex (MMC) between April and September 2023. Pregnant women having cesarean sections elective or emergency were administered 10–15 mg of 0.75% hyperbaric bupivacaine using a 23–25G Quincke spinal needle. A pre-designed questionnaire was used to document patient demographics, clinical details, as well as spinal anesthesia details of each patient. All the variables were analyzed with the help of SPSS version 22.

Results: Among the 149 pregnant women who received spinal anesthesia, 17 (11.4%) experienced “failed” outcomes, where the spinal anesthesia did not work as intended. Conversely, 132 (88.6%) had “successful” outcomes, indicating effective administration of spinal anesthesia. A portion of 11 (8.7%), represented “partial failure,” where the anesthesia had some success but did not achieve adequate anesthesia. While complete failure accounted for 4 (2.7%) of cases, signifying instances where spinal anesthesia did not work completely. Conclusion and Recommendations: The frequency of failed spinal anesthesia in pregnant women undergoing cesarean section at MMC was high at 11.40%.

Keywords

References (22)

  1. Punchuklang W, Nivatpumin P, Jintadawong T. Total failure of spinal anesthesia for cesarean delivery, associated factors, and outcomes: A retrospective case–control study. Medicine. 2022;101(27):e29813. doi:10.1097/md.0000000000029813
  2. At A, So O. Failed spinal anaesthesia for caesarean section. J West Afr Coll Surg. 2011 Oct;1(4):1-17. PMID: 25452968; PMCID: PMC4170277.
  3. Alabi AA, Adeniyi OV, Adeleke OA, Pillay P, Haffajee MR. Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa. South African Family Practice. 2017;59(4):128-132. doi:10.1080/20786190.2017.1292696
  4. Cooper GM, McClure JH. Maternal deaths from anaesthesia. An extract from Why Mothers Die 2000–2002 , the Confidential Enquiries into Maternal Deaths in the United Kingdom † †This article is accompanied by the Editorial. British Journal of Anaesthesia. 2005;94(4):417-423. doi:10.1093/bja/aei066
  5. Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections*. Anaesthesia. 2008;63(8):822-832. doi:10.1111/j.1365-2044.2008.05499.x
  6. Ashagrie HE, Ahmed SA, Melesse DY. The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: A prospective observational study. International Journal of Surgery Open. 2020;24:47-51. doi:10.1016/j.ijso.2020.03.009
  7. Rukewe A, Adebayo OK, Fatiregun AA. Failed Obstetric Spinal Anesthesia in a Nigerian Teaching Hospital. Anesthesia & Analgesia. 2015;121(5):1301-1305. doi:10.1213/ane.0000000000000868
  8. No BZ. Subjective failed spinal anesthesia in cesarean section; Type, management, and associated factors. Res Artic J Anesth Clin Res. 2022;13(3):1001048.
  9. Colvin JR, Peden CJ, editors. Raising the Standard: a Compendium of Audit Recipes for Continuous Quality Improvement in Anaesthesia. 3rd ed. London: The Royal College of Anaesthetists; 2012.
  10. Levy JH, Islas JA, Ghia JN, Turnbull C. A Retrospective Study of the Incidence and Causes of Failed Spinal Anesthetics in a University Hospital. Anesthesia & Analgesia. 1985;64(7):705???710. doi:10.1213/00000539-198507000-00010
  11. Bekele Z, Jisha H. Type, management, and associated factors of failed spinal anesthesia in cesarean section. Prospective cohort study. Annals of Medicine & Surgery. 2022;77. doi:10.1016/j.amsu.2022.103616
  12. Fettes PDW, Jansson JR, Wildsmith JAW. Failed spinal anaesthesia: mechanisms, management, and prevention. British Journal of Anaesthesia. 2009;102(6):739-748. doi:10.1093/bja/aep096
  13. Wenk M, Weiss C, Möllmann M, Pöpping DM. Procedural Complications of Spinal Anaesthesia in the Obese Patient. Anesthesiology Research and Practice. 2012;2012:1-5. doi:10.1155/2012/165267
  14. Kilawe A. Prevalence and factors associated with failed spinal anesthesia in failed spinal anesthesia undergoing cesarean section at Muhimbili National Hospital Dar-Es-Salaam. Tanzania. 2019.
  15. Halimi NN, Basit M, Waqas HM, Khan MJ, Ilyas M. To determine the frequency of failed spinal anaesthesia during cesarean section. Pak J Surg. 2020;36(1):71–4.
  16. A prospective, observational audit of failed regional anaesthesia in 4085 caesarean sections at a tertiary care hospital. Indian Journal of Clinical Anaesthesia. 2020;5(1):50-55. doi:10.18231/2394-4994.2018.0009
  17. Alabi AA, Adeniyi OV, Adeleke OA, Pillay P, Haffajee MR. Factors associated with failed spinal anesthesia for cesarean sections in Mthatha General Hospital, Eastern Cape, South Africa. S Afr Fam Pract. 2017;59(4):128–32.
  18. At A, So O. Failed spinal anaesthesia for caesarean section. J West Afr Coll Surg. 2011 Oct;1(4):1-17. PMID: 25452968; PMCID: PMC4170277.
  19. Nani FS, Torres MLA. Correlation between the Body Mass Index (BMI) of Pregnant Women and the Development of Hypotension after Spinal Anesthesia for Cesarean Section. Brazilian Journal of Anesthesiology. 2011;61(1):21-30. doi:10.1016/s0034-7094(11)70003-4
  20. Dresner MR, Freeman JM. Anaesthesia for caesarean section. Best Practice & Research Clinical Obstetrics & Gynaecology. 2001;15(1):127-143. doi:10.1053/beog.2000.0153
  21. Ruzman T, Harsanji-Drenjancevic I, Gulam D, Burazin J, Venzera-Azenic D, Ruzman N. Factors associated with difficult neuraxial blockade. Local and Regional Anesthesia. 2014:47. doi:10.2147/lra.s68451
  22. Sng BL, Lim Y, Sia ATH. An observational prospective cohort study of incidence and characteristics of failed spinal anaesthesia for caesarean section. International Journal of Obstetric Anesthesia. 2009;18(3):237-241. doi:10.1016/j.ijoa.2009.01.010