title: Anesthetic management of prophylactic cervical cerclage: a retrospective multicenter cohort study.
abstract: OBJECTIVE
  Cervical incompetence complicates approximately 1 in 500 pregnancies and is the most common cause of second-trimester spontaneous abortion and preterm labor. No prospective or large retrospective studies have compared regional and general anesthesia for cervical cerclage.
  
  
  METHODS
  Following IRB approval, we performed a retrospective study in the two main medical centers over an 8-year period to assess the association of anesthesia choice with anesthetic and obstetric outcomes. Anesthetic and perioperative details were retrospectively collected from fails of all patients undergoing cervical cerclage from 01/01/2005 until 31/12/2012. Details included demographic data, anesthetic technique, PACU data and perioperative complications.
  
  
  RESULTS
  We identified 487 cases of cervical cerclage in 327 women during the study period. The most commonly used anesthetic technique was general anesthesia (GA) (402/487; 82.5%) compared with regional anesthesia (RA) (85/487; 17.5%). When GA was performed, facemask was the most commonly used technique (275/402; 68.4%), followed by intravenous deep sedation (61/402; 15.2%); LMA (51/402; 12.7%) and tracheal intubation (13/402; 3.2%). There were no significant differences in demographic characteristics between women receiving general and regional anesthesia. Average duration of suturing the cervix among the GA group was 9.8 ± 1.6 and 10.6 ± 2.1 min in the RA group (p < 0.001). Average length of stay in the operating room in the GA group was 20.5 ± 3.9 and 23 ± 4.6 min in the RA group (p < 0.001). Patients receiving GA received in the PACU more opioids (6.2 versus 1.2%; p < 0.05) and more non-opioids analgesics (36.8 versus 9.4%; p < 0.001). Duration of PACU stay was shorter after GA (49.5 ± 18 min) than after RA (62.4 ± 28 min; p < 0.001). There were no other differences in anesthetic or perioperative outcome between groups. This study was not designed to provide evidence that RA reduces the risk of pulmonary aspiration, airway complications or adverse fetal neurological effects from maternal anesthetic exposure.
  
  
  CONCLUSIONS
  Both regional and general anesthesia were safely used for the performance of cerclage. Patients after general anesthesia had a shorter recovery time but a higher demand for opioids and non-opioids analgesia.
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, Hebrew University, POB 3235, Jerusalem, 91031, Israel, aioscovich@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ioscovich
authors.forename: Alla
authors.initials: A
authors.lastname: Popov
authors.forename: Yuri
authors.initials: Y
authors.lastname: Gimelfarb
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Gozal
authors.forename: Sharon
authors.initials: S
authors.lastname: Orbach-Zinger
authors.forename: Joel
authors.initials: J
authors.lastname: Shapiro
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Ginosar
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000777:Anesthetics / Q000008:administration & dosage*; D023802:Cerclage, Cervical; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000517:prevention & control*
chemical_list: D000777:Anesthetics