Maternal sedation during scheduled versus unscheduled cesarean delivery: implications for skin-to-skin contact

J. B. Bavaro*, J. L. Mendoza, R. J. McCarthy, P. Toledo, J. R. Bauchat

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 60 min following a T4 sensory level. The primary outcomes were patient-reported sedation at 45 min and the areas under the sedation curves. Results Patient-reported levels of sedation were greater at 45 min 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.

Original languageEnglish (US)
Pages (from-to)17-24
Number of pages8
JournalInternational Journal of Obstetric Anesthesia
Volume27
DOIs
StatePublished - Aug 1 2016

Fingerprint

Mothers
Skin
Area Under Curve
Epidural Anesthesia
Spinal Anesthesia
Operating Rooms
Breast Feeding
Newborn Infant
Safety

Keywords

  • Cesarean delivery
  • Epidural anesthesia
  • Sedation
  • Skin-to-skin
  • Spinal anesthesia

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Anesthesiology and Pain Medicine

Cite this

@article{f7e0bd35e4d4490187af7859c5c9a6de,
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 60 min following a T4 sensory level. The primary outcomes were patient-reported sedation at 45 min and the areas under the sedation curves. Results Patient-reported levels of sedation were greater at 45 min 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.",
keywords = "Cesarean delivery, Epidural anesthesia, Sedation, Skin-to-skin, Spinal anesthesia",
author = "Bavaro, {J. B.} and Mendoza, {J. L.} and McCarthy, {R. J.} and P. Toledo and Bauchat, {J. R.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1016/j.ijoa.2016.06.003",
language = "English (US)",
volume = "27",
pages = "17--24",
journal = "International Journal of Obstetric Anesthesia",
issn = "0959-289X",
publisher = "Churchill Livingstone",

}

Maternal sedation during scheduled versus unscheduled cesarean delivery : implications for skin-to-skin contact. / Bavaro, J. B.; Mendoza, J. L.; McCarthy, R. J.; Toledo, P.; Bauchat, J. R.

In: International Journal of Obstetric Anesthesia, Vol. 27, 01.08.2016, p. 17-24.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Maternal sedation during scheduled versus unscheduled cesarean delivery

T2 - implications for skin-to-skin contact

AU - Bavaro, J. B.

AU - Mendoza, J. L.

AU - McCarthy, R. J.

AU - Toledo, P.

AU - Bauchat, J. R.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - 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 60 min following a T4 sensory level. The primary outcomes were patient-reported sedation at 45 min and the areas under the sedation curves. Results Patient-reported levels of sedation were greater at 45 min 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.

AB - 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 60 min following a T4 sensory level. The primary outcomes were patient-reported sedation at 45 min and the areas under the sedation curves. Results Patient-reported levels of sedation were greater at 45 min 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.

KW - Cesarean delivery

KW - Epidural anesthesia

KW - Sedation

KW - Skin-to-skin

KW - Spinal anesthesia

UR - http://www.scopus.com/inward/record.url?scp=84990876589&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990876589&partnerID=8YFLogxK

U2 - 10.1016/j.ijoa.2016.06.003

DO - 10.1016/j.ijoa.2016.06.003

M3 - Article

C2 - 27406578

AN - SCOPUS:84990876589

VL - 27

SP - 17

EP - 24

JO - International Journal of Obstetric Anesthesia

JF - International Journal of Obstetric Anesthesia

SN - 0959-289X

ER -