Impact of anesthesiologist's fellowship status on the risk of general anesthesia for unplanned cesarean delivery

Acta Anaesthesiol Scand. 2019 Jul;63(6):769-774. doi: 10.1111/aas.13350. Epub 2019 Mar 21.


Background: Neuraxial analgesia is preferred over general anesthesia for cesarean delivery (CD), particularly in the presence of a labor epidural catheter. We hypothesize that care by a non-obstetric anesthesiologist as compared to care by an obstetric anesthesiologist is associated with a higher risk for use of general anesthesia for CD for patients with a preexisting labor epidural catheter.

Methods: To determine whether fellowship status of the covering anesthesiologist was a risk factor for general anesthesia, we retrospectively investigated the rate of general anesthesia use in patients with epidural catheters placed for labor analgesia who subsequently required CD. To standardize the practice environment under which these cases occurred, we examined only cases which occurred during coverage by the call team on nights, weekends, and holidays.

Results: There were 1820 cases in which a patient had epidural labor analgesia followed by a CD. Nine hundred and twelve cases were covered by an obstetric anesthesiologist and 908 cases were covered by a non-obstetric anesthesiologist. General anesthesia was used in only 16 of these cases. General anesthesia was more likely to be performed by non-obstetric fellowship trained anesthesiologists (1.54% or 14/908 compared to 0.22% or 2/912; P = 0.002).

Conclusions: This investigation suggests that the presence of an obstetric fellowship-trained anesthesiologist may be a predictor of decreased rate of general anesthesia use in patients with preexisting indwelling labor epidural catheters.

Keywords: cesarean delivery; graduate medical education; labor epidural; obstetric anesthesia.

MeSH terms

  • Adult
  • Analgesia, Epidural
  • Anesthesia, General / adverse effects*
  • Anesthesia, Obstetrical / adverse effects*
  • Anesthesiologists / education*
  • Cesarean Section*
  • Fellowships and Scholarships*
  • Female
  • Humans
  • Logistic Models
  • Pregnancy
  • Retrospective Studies
  • Risk