What is the most common complication of general anesthesia in women undergoing a cesarean section: failed intubation or postoperative nausea and vomiting (PONV)?

From the Guidelines

Postoperative nausea and vomiting (PONV) is the most common complication of general anesthesia in women undergoing cesarean section, not failed intubation. PONV affects approximately 60-80% of women after cesarean delivery under general anesthesia, while failed intubation is rare, occurring in about 1 in 300 obstetric general anesthetics 1. Women undergoing cesarean section are particularly susceptible to PONV due to multiple risk factors including female gender, pregnancy-related hormonal changes, abdominal surgery, and opioid use for postoperative pain management. Some key points to consider in the management of PONV include:

• The use of multimodal prophylaxis with medications such as ondansetron, dexamethasone, and metoclopramide given before the end of surgery 1
• The implementation of non-pharmacological techniques such as minimal preoperative fasting, carbohydrate loading, and adequate hydration of patients 1
• The consideration of total intravenous anesthesia (TIVA) rather than volatile gases and multimodal analgesia rather than the liberal use of opioids 1
• The use of high inspired oxygen concentrations during anesthesia and regional anaesthetic techniques such as epidurals and transversus abdominal plane (TAP) blocks 1 For treatment of established PONV, ondansetron can be given if not used for prophylaxis, or alternatives like promethazine or droperidol may be used 1. The high incidence of PONV relates to the physiological changes of pregnancy, including delayed gastric emptying, increased gastric pressure, and heightened sensitivity to emetogenic stimuli, combined with the effects of anesthetic agents and postoperative pain management. It is essential to note that failed intubation, although rare, is a critical complication that requires prompt management, as outlined in the Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines 1. However, in terms of common complications, PONV remains the most significant concern in women undergoing cesarean section under general anesthesia.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Complications of General Anesthesia in Cesarean Section

• The most common complication of general anesthesia in women undergoing a cesarean section is postoperative nausea and vomiting (PONV) 2, 3, 4.
• PONV is a common and distressing side effect of anesthesia and surgery, and it can increase patient dissatisfaction and have psychological and physical effects 2.
• The incidence of PONV can be as high as 80% in parturients undergoing cesarean delivery with neuraxial anesthesia 4.
• Failed intubation is a serious complication, but it is not as common as PONV in cesarean sections 5.
• Various studies have investigated the prevention and management of PONV, including the use of antiemetic prophylaxis, multimodal approaches, and alternative therapies such as acupressure 3, 4, 6.

Prevention and Management of PONV

• Preventing PONV is important to reduce patient dissatisfaction and improve outcomes 2.
• A multimodal approach, including antiemetic prophylaxis and optimizing analgesia, can be effective in reducing the risk of PONV 4.
• The use of combination prophylactic antiemetic therapy has been shown to be effective in reducing the incidence of PONV 3.
• Alternative therapies, such as acupressure, have also been found to be effective in preventing PONV 6.