title: Spinal anesthesia for intrapartum Cesarean delivery following epidural labor analgesia: a retrospective cohort study.
abstract: OBJECTIVE
  Failed conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum Cesarean delivery (CD) has been observed in clinical practice. However, spinal anesthesia (SA) in parturients experiencing failed conversion of ELA to ESA has been associated with an increased incidence of serious side effects. In this retrospective cohort analysis, we examined our routine clinical practice of removing the in situ epidural, rather than attempting to convert to ESA, prior to administering SA for intrapartum CD.
  
  
  METHODS
  Hemodynamic data, frequencies of either high or total spinal block, and maternal and neonatal outcome data were gathered from the anesthesia records of all parturients at the Amphia Hospital, undergoing intrapartum CD between January 1, 2001 and May 1, 2005.
  
  
  RESULTS
  Complete data were available for 693 patients (97.6%) of the 710 medical records that were identified. Of the 693 patients, 508 (73.3%) had no ELA and received SA, 128 patients (18.5%) received SA following epidural anesthesia for labor, 19 (2.7%) underwent conversion of ELA to ESA, and 38 (5.5%) received general anesthesia. When comparing both SA groups, no clinically relevant differences were observed regarding the incidence of total spinal block (0% in both groups) or high spinal block (0.2 vs 0.8%, P = 0.36). The number of hypotensive episodes, the total amount of ephedrine administered, and the Apgar scores recorded at 5 and 10 min were similar amongst groups.
  
  
  CONCLUSIONS
  The incidence of serious side effects associated with SA for intrapartum CD following ELA is low and not different compared to SA only.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, P.O. Box 90157, Breda 4800 RL, The Netherlands. avisser@amphia.nl
authors.forename: W Anton
authors.initials: WA
authors.lastname: Visser
authors.forename: Annemieke
authors.initials: A
authors.lastname: Dijkstra
authors.forename: Mustafa
authors.initials: M
authors.lastname: Albayrak
authors.forename: Mathieu J M
authors.initials: MJ
authors.lastname: Gielen
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Vonsée
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D012189:Retrospective Studies