General anesthesia for cesarean delivery: Israeli national survey

Abstract Background Cesarean delivery is one of the most common surgeries performed worldwide. Given the unavoidable use of general anesthesia in some situations, and the potential for complications, we performed a multicenter national survey in order to investigate aspects related to the use of gen...

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Main Authors: Daniel Shatalin, Yair Binyamin, Jacob Weinstein, Jana Pirogov, Carolyn F. Weiniger, Sharon Orbach-Zinger, Alexander Ioscovich
Format: Article
Language:English
Published: BMC 2025-07-01
Series:Journal of Anesthesia, Analgesia and Critical Care
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Online Access:https://doi.org/10.1186/s44158-025-00257-8
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author Daniel Shatalin
Yair Binyamin
Jacob Weinstein
Jana Pirogov
Carolyn F. Weiniger
Sharon Orbach-Zinger
Alexander Ioscovich
author_facet Daniel Shatalin
Yair Binyamin
Jacob Weinstein
Jana Pirogov
Carolyn F. Weiniger
Sharon Orbach-Zinger
Alexander Ioscovich
author_sort Daniel Shatalin
collection DOAJ
description Abstract Background Cesarean delivery is one of the most common surgeries performed worldwide. Given the unavoidable use of general anesthesia in some situations, and the potential for complications, we performed a multicenter national survey in order to investigate aspects related to the use of general anesthesia for cesarean delivery. Methods This multicenter national survey questionnaire study was performed from October 2020 to March 2021. After Institutional Review Board waiver, we surveyed 25 eligible medical centers with an active obstetric anesthesia unit. The survey covered issues related to general anesthesia: preoperative management, personnel, induction, maintenance and emergence phases of anesthesia, intraoperative and postoperative pain management, protocol use, availability of difficult airway algorithm, and complications that are related to cesarean delivery under general anesthesia. Results A total of 113 participants among the 25 medical centers participated in the study. Routine pharmacological aspiration prophylaxis use was reported by 100/113 (88.5%). Administration of opiates during induction before fetal delivery was in 16.8%. We found only 27/113 (23.9%) of respondents ventilate their patients during RSI. Routine use of depth of anesthesia monitoring was reported by 21/113 (18.6%) respondents. Routine postoperative intravenous patient-controlled analgesia (IV-PCA) use with morphine was reported by 6/113 (5.3%) respondents. Conclusions In this national survey, we emphasize the importance of the presence of highly qualified anesthesiologic personnel during the surgery, benefit from the use of short-acting opiates during induction, availability of videolaryngoscope, ventilation of the patient during RSI, and availability of institutional difficult airway protocols. We observe underuse of intraoperative anesthesia-depth monitoring and poor postoperative pain control.
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spelling doaj-art-d869aeb4aa4d4a30b791f61af6d2bb3b2025-08-20T04:01:42ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862025-07-01511910.1186/s44158-025-00257-8General anesthesia for cesarean delivery: Israeli national surveyDaniel Shatalin0Yair Binyamin1Jacob Weinstein2Jana Pirogov3Carolyn F. Weiniger4Sharon Orbach-Zinger5Alexander Ioscovich6Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center affiliated with The Hebrew UniversityDepartment of Anaesthesia, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the NegevDepartment of Anesthesiology, Sheba Medical Center, Tel Aviv UniversityDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center affiliated with The Hebrew UniversityDivision of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Centre affiliated with Gray Faculty of Medical and Health Sciences, Tel Aviv UniversityDepartment of Anesthesiology, Beilinson Hospital, Rabin Medical CentreDepartment of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center affiliated with The Hebrew UniversityAbstract Background Cesarean delivery is one of the most common surgeries performed worldwide. Given the unavoidable use of general anesthesia in some situations, and the potential for complications, we performed a multicenter national survey in order to investigate aspects related to the use of general anesthesia for cesarean delivery. Methods This multicenter national survey questionnaire study was performed from October 2020 to March 2021. After Institutional Review Board waiver, we surveyed 25 eligible medical centers with an active obstetric anesthesia unit. The survey covered issues related to general anesthesia: preoperative management, personnel, induction, maintenance and emergence phases of anesthesia, intraoperative and postoperative pain management, protocol use, availability of difficult airway algorithm, and complications that are related to cesarean delivery under general anesthesia. Results A total of 113 participants among the 25 medical centers participated in the study. Routine pharmacological aspiration prophylaxis use was reported by 100/113 (88.5%). Administration of opiates during induction before fetal delivery was in 16.8%. We found only 27/113 (23.9%) of respondents ventilate their patients during RSI. Routine use of depth of anesthesia monitoring was reported by 21/113 (18.6%) respondents. Routine postoperative intravenous patient-controlled analgesia (IV-PCA) use with morphine was reported by 6/113 (5.3%) respondents. Conclusions In this national survey, we emphasize the importance of the presence of highly qualified anesthesiologic personnel during the surgery, benefit from the use of short-acting opiates during induction, availability of videolaryngoscope, ventilation of the patient during RSI, and availability of institutional difficult airway protocols. We observe underuse of intraoperative anesthesia-depth monitoring and poor postoperative pain control.https://doi.org/10.1186/s44158-025-00257-8Cesarean deliveryGeneral anesthesiaObstetric anesthesiaSurvey
spellingShingle Daniel Shatalin
Yair Binyamin
Jacob Weinstein
Jana Pirogov
Carolyn F. Weiniger
Sharon Orbach-Zinger
Alexander Ioscovich
General anesthesia for cesarean delivery: Israeli national survey
Journal of Anesthesia, Analgesia and Critical Care
Cesarean delivery
General anesthesia
Obstetric anesthesia
Survey
title General anesthesia for cesarean delivery: Israeli national survey
title_full General anesthesia for cesarean delivery: Israeli national survey
title_fullStr General anesthesia for cesarean delivery: Israeli national survey
title_full_unstemmed General anesthesia for cesarean delivery: Israeli national survey
title_short General anesthesia for cesarean delivery: Israeli national survey
title_sort general anesthesia for cesarean delivery israeli national survey
topic Cesarean delivery
General anesthesia
Obstetric anesthesia
Survey
url https://doi.org/10.1186/s44158-025-00257-8
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AT janapirogov generalanesthesiaforcesareandeliveryisraelinationalsurvey
AT carolynfweiniger generalanesthesiaforcesareandeliveryisraelinationalsurvey
AT sharonorbachzinger generalanesthesiaforcesareandeliveryisraelinationalsurvey
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