General anesthesia for cesarean delivery: Israeli national survey

Background: Cesarean delivery is one of the most common surgeries performed worldwide. Given the unavoidable use of general anesthesia in some situations, and the potential for complications, we performed a multicenter national survey in order to investigate aspects related to the use of general anesthesia for cesarean delivery. Methods: This multicenter national survey questionnaire study was performed from October 2020 to March 2021. After Institutional Review Board waiver, we surveyed 25 eligible medical centers with an active obstetric anesthesia unit. The survey covered issues related to general anesthesia: preoperative management, personnel, induction, maintenance and emergence phases of anesthesia, intraoperative and postoperative pain management, protocol use, availability of difficult airway algorithm, and complications that are related to cesarean delivery under general anesthesia. Results: A total of 113 participants among the 25 medical centers participated in the study. Routine pharmacological aspiration prophylaxis use was reported by 100/113 (88.5%). Administration of opiates during induction before fetal delivery was in 16.8%. We found only 27/113 (23.9%) of respondents ventilate their patients during RSI. Routine use of depth of anesthesia monitoring was reported by 21/113 (18.6%) respondents. Routine postoperative intravenous patient-controlled analgesia (IV-PCA) use with morphine was reported by 6/113 (5.3%) respondents. Conclusions: In this national survey, we emphasize the importance of the presence of highly qualified anesthesiologic personnel during the surgery, benefit from the use of short-acting opiates during induction, availability of videolaryngoscope, ventilation of the patient during RSI, and availability of institutional difficult airway protocols. We observe underuse of intraoperative anesthesia-depth monitoring and poor postoperative pain control.