Evidence map›Paper›PMID 39382641›Full record

ArticleJournal of anesthesia2025

Anesthetic and obstetric predictors of general anesthesia in urgent or emergent Cesarean delivery: a retrospective case-control study.

G Raghavan, N Siddiqui, W Whittle, K Downey, X Y Ye, J C A Carvalho

Abstract read
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In one paragraph

Article in Journal of anesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

G RaghavanDepartment of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada. gita.raghavan@sinaihealth.ca.
N SiddiquiDepartment of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada.
W WhittleDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
K DowneyDepartment of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada.
X Y YeDepartment of Biostatistics, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
J C A CarvalhoDepartment of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeWhile regional anesthesia (RA) is considered preferable to general anesthesia (GA) for Cesarean delivery (CD), certain situations necessitate GA. This study reviewed the practice patterns around the use of GA for CD to identify modifiable predictors of GA with the goal of reducing GA rates.

methodsThis was a retrospective, case-control study. Patients undergoing urgent/emergent CD over a 3-year period were identified, from which 102 patients undergoing GA and 102 patients undergoing RA were randomly selected. The data included patient characteristics, obstetrical indications for CD, type/indication of anesthetic, characteristics of airway management (GA group)/neuraxial anesthesia (RA group), and neonatal outcomes.

resultsAbnormal fetal heart rate (aFHR) was the most common obstetrical indication for urgent/emergent CD amongst the cases (39%) and controls (39%). GA administration was most commonly due to "limited time due to maternal/fetal compromise" (56%), followed by "maternal contraindication to RA" (25%) and "inadequate RA" (17%). The most frequent modifiable anesthetic indication for GA was inadequate neuraxial anesthesia (17%). Anesthetic and obstetric predictors for GA included ASA classification [OR 0.11 (0.06-0.21)], emergency code activation [OR 13.55 (1.73-106.40)], failure to progress [OR 0.15 ((0.06-0.36)], labor in a patient scheduled for CD [OR 0.16 (0.05-0.57)], pregnancy-related illness [OR 8.63 (1.06-70.38)], cord/fetal prolapse [14.85(1.90-115.94)], and gestational age (OR 0.86 (0.81-0.92)).

conclusionAbnormal fetal heart rate, specifically bradycardia, was the most common obstetrical indication of GA for urgent/emergent CD, while inadequate neuraxial anesthesia was the most  modifiable anesthetic indication. Our data suggest aFHR and cord/fetal prolapse as potentially modifiable risk factors for GA in certain situations.

Indexed as

Anesthesia, GeneralAnesthesia, ObstetricalCesarean SectionAdultAnesthesia, ConductionCase-Control StudiesFemaleHeart Rate, FetalHumansInfant, NewbornPregnancyRetrospective StudiesCesarean deliveryGeneral anesthesiaPredictors

Identifiers

PMID39382641

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.