title: Anesthetic technique for cesarean delivery and neonatal acid-base status: a retrospective database analysis.
abstract: BACKGROUND
  A previous meta-analysis reported lower umbilical artery pH with spinal anesthesia for cesarean delivery compared to general or epidural anesthesia. Ephedrine was used in the majority of studies. The objective of this study was to evaluate the effect of anesthetic technique on neonatal acid-base status now that phenylephrine has replaced ephedrine in our institution.
  
  
  METHODS
  We retrospectively reviewed our database to identify patients who underwent cesarean delivery and had umbilical artery pH available. We decided a priori to test separately cases where cesarean delivery was performed emergently (category I and II) or non-emergently (category III and IV). Multivariable models were constructed to detect significant predictors of lower umbilical artery pH.
  
  
  RESULTS
  One thousand sixty-four cases were included (647 emergent, 417 non emergent). In emergent cesarean delivery, anesthesia type was a significant predictor of lower umbilical artery pH (P <0.0001) with the pairwise comparisons showing lower neonatal umbilical artery pH [mean (95% CI)] with general anesthesia [7.16 (7.13, 7.19)] compared with spinal anesthesia [7.24 (7.22, 7.25)] and epidural anesthesia [7.23 (7.21, 7.24)], with no difference between spinal and epidural anesthesia. When excluding cases where general anesthesia was chosen due to insufficient time to place a neuraxial block or dose an existing epidural catheter, anesthesia type was not a predictor of lower umbilical artery pH. Anesthetic technique was not a predictor of lower umbilical artery pH in non-emergent cases.
  
  
  CONCLUSIONS
  Spinal anesthesia was not associated with lower umbilical artery pH compared to other types of anesthesia. This might be due to the use of phenylephrine in our practice.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Strouch
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Dakik
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
authors.forename: W D
authors.initials: WD
authors.lastname: White
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. Electronic address: habib001@dm.duke.edu.
authors.forename: A S
authors.initials: AS
authors.lastname: Habib
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000328:Adult; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data*; D000773:Anesthesia, Obstetrical / Q000379:methods / Q000706:statistics & numerical data*; D000775:Anesthesia, Spinal / Q000706:statistics & numerical data*; D002585:Cesarean Section; D016208:Databases, Factual; D005260:Female; D005312:Fetal Blood; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007231:Infant, Newborn; D012189:Retrospective Studies; D014469:Umbilical Arteries
keywords: Anesthesia; Cesarean delivery; Phenylephrine; Spinal