title: Maternal sedation during scheduled versus unscheduled cesarean delivery: implications for skin-to-skin contact.
abstract: BACKGROUND
  Early maternal skin-to-skin contact confers numerous benefits to the newborn, but maternal sedation during cesarean delivery could have safety implications for early skin-to-skin contact in the operating room. We compared patient-reported and observer-assessed levels of sedation during unscheduled and scheduled cesarean deliveries.
  
  
  METHODS
  Laboring women undergoing unscheduled cesarean delivery with epidural anesthesia, and scheduled cesarean delivery with spinal anesthesia were enrolled. Sedation levels, measured using patient-reported (1=least sedated to 10=most sedated) and observer-assessed (0=most sedated to 5=least sedated) scales, were evaluated at baseline and 15, 30, 45, and 60min following a T4 sensory level. The primary outcomes were patient-reported sedation at 45min and the areas under the sedation curves.
  
  
  RESULTS
  Patient-reported levels of sedation were greater at 45min in laboring women undergoing unscheduled (median 7.5, IQR 5-9) versus scheduled cesarean delivery (median 4, IQR 3-6) (difference in medians 3.5, 99% CI 0 to 5). Observer-assessed sedation was not different between groups. The area under the time curve for patient-reported sedation was greater in the unscheduled group, median difference 162 score min (95% CI 52 to 255). The area under the time curve for observer-assessed sedation was greater in the unscheduled group, median difference 26 score min (99% CI 0 to 41). Times to skin-to-skin contact and breastfeeding were not different.
  
  
  CONCLUSIONS
  Women undergoing unscheduled cesarean deliveries are more sedated than women undergoing scheduled cesarean deliveries. Skin-to-skin protocols for cesarean deliveries must consider maternal sedation and anesthesiologists should use sedating medications judiciously.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: joseph.bavaro@northwestern.edu.
authors.forename: J B
authors.initials: JB
authors.lastname: Bavaro
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Mendoza
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: McCarthy
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: P
authors.initials: P
authors.lastname: Toledo
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Bauchat
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001942:Breast Feeding; D002585:Cesarean Section; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011446:Prospective Studies; D064232:Visual Analog Scale
keywords: Cesarean delivery; Epidural anesthesia; Sedation; Skin-to-skin; Spinal anesthesia