• Marie-Pierre Bonnet, Frédéric J Mercier, Eric Vicaut, Anne Galand, Hawa Keita, Christophe Baillard, and CAESAR working group.
• Department of Anaesthesiology and Critical Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
• Br J Anaesth. 2020 Jul 1; 125 (1): e81-e87.

BackgroundPregnant women are at increased risk of hypoxaemia during general anaesthesia. Our aim was to determine the incidence and the risk factors that contribute to hypoxaemia in this setting.MethodsEvery woman 18 yr or older who underwent a non-elective Caesarean section under general anaesthesia was eligible to participate in this multicentre observational study. The primary endpoint was the incidence of hypoxaemia defined as the SpO2 ≤95%. The secondary endpoint was the incidence of difficult intubation defined as more than two attempts or failed intubation.ResultsDuring the study period, 895 women were prospectively included in 17 maternity hospitals, accounting for 79% of women who had general anaesthesia for non-elective Caesarean section. Maternal hypoxaemia was observed in 172 women (19%; confidence interval [CI], 17-22%). Risk factors associated with hypoxaemia in the multivariate analysis were difficult or failed intubation (adjusted odds ratio [aOR]=19.1 [8.6-42.7], P<0.0001) and BMI >35 kg m-2 (aOR=0.53 [0.28-0.998], P=0.0495). Intubation was difficult in 40 women (4.5%; CI, 3.3-6%) and failed intubation occurred in five women (0.56%; CI, 0.1-1%). In the multivariate analysis, use of a hypnotic drug other than propofol was associated with difficult or failed intubation (aOR=25 [2-391], P=0.02). A propensity score confirmed that propofol was associated with a significant decreased risk of difficulty or failure to intubate (P<0.001).ConclusionsHypoxaemia during Caesarean sections was observed in 19% of women and was significantly associated with difficult or failed intubation. The use of propofol may protect against the occurrence of difficult intubation.Copyright © 2020. Published by Elsevier Ltd.

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