Factors Influencing Epidural Anesthesia for Cesarean Section Outcome

摘要

This study investigates practice variance in performing epidural anesthesia for cesarean section. Specifically, we analyze the safety and efficacy of a large-dose, needle-based epidural technique where anesthetic dose is administered through an epidural needle prior to insertion of the epidural catheter. Using a data-driven informatics and machine learning approach, our findings show that the needle-based technique is faster and more dose-effective in achieving sensory level than the catheter- based approach. We also find that injecting large doses in the epidural space through the epidural needle is safe, with complication rates similar to those reported in published literature. Further, machine learning reveals that a needle dose of at most 18 ml offers lower hypotension complication. The machine learning framework can predict hypotension incidents with 85% accuracy. The findings facilitate delivery improvement and establish an improved clinical practice guideline for training and dissemination of safe practice. Successful prediction of hypotension allows for early intervention to minimize the effects of complication. Furthermore, although almost 50% of the drug combinations used involve fentanyl, our findings show that fentanyl has little effect on the outcome and should be avoided in epidural anesthesia.