General Anesthesia in Cesarean Sections: a prospective review of 465 cesarean sections performed under general anesthesia

Background: In many countries, neuraxial blocks comprise the majority of anesthetics given for cesarean section. In Iran, however general anesthesia for cesarean section is prevalent. In our institution, the rate of general anesthesia for cesarean section is 39%, providing an opportunity to collect data regarding airway management in the parturients. We report on the outcomes of a series of patients who received general anesthesia for cesarean section. Methods: A prospective observational study was conducted in two university hospitals, with approximately 5,500 deliveries annually. Demographics and airway characteristics were recorded. Eight potential risk factors for difficult intubation (short neck, obesity, facial edema, swollen tongue, receding mandible, and single, missing or protruding maxillary incisors) were analyzed. Then, laryngoscopic view, difficulty at intubation, and major complications were recorded. Results: Data were obtained from 465 patients. There was a significant correlation between higher Mallampati score and both higher laryngoscopic view graded on the Cormack-Lehane system (P 0.001) and difficulty at intubation (P-Value=0.05). Emergency cesarean section was not associated with difficult intubation (P=0.67). Multivariate analysis showed that receding mandible was the only potential risk factor for difficult tracheal intubation (P 0.001) and removed short neck or protruding maxillary incisor which initially was powered as a risk factor by univariate analysis. A grade 3 laryngoscopic view was obtained in 15 cases (3.2%). There was no case of grade 4 view. There was only one failed intubation (0.2%), and 9 cases of very difficult intubation (1.9%). Conclusion: General anesthesia for cesarean section is safe with minimal risk.