General or neuraxial anesthesia: what is best choice for red code cesarean section?

Objective. Red code (RC) cesarean section (CS) is an obstetrics emergency performed for immediate risk for the life of the woman or the fetus. We have assessed the role of anesthesia on obstetrics and perinatal outcomes in patients who underwent RC CS.
Materials and Methods. A multicenter retrospective cohort study in four maternity units including all cases of RC CS between January 2018 and December 2021. We collected medical and surgical reports, intrapartum fetal heart rate monitoring. Patients who underwent analgesia during labor were excluded.
Outcomes were related to the anesthesiology technique utilized (general anesthesia – GenA versus neuraxial anesthesia – NeuraxA). Retrospective audits were performed by an expert obstetric team for assessment of appropriateness of indications for RC CS.
Results. From a total of 168 RC CS (3.5% of deliveries), 122 (72.4 %) cases were included. GenA (45.1%) was compared with NeuraxA (54.9%). While GenA was associated with a shorter decision-to-delivery interval (DDI) (p = 0.028) and better umbilical artery (UA) pH (p = 0.005), it was related to a greater blood loss (p = 0.006), UA base excess (BE) < -16 mmol/L (p = 0.013) and need for neonate reanimation (p = 0.028).
Moreover, on multivariate analysis, only appropriateness of indication for RC CS (p = 0.003) and GenA (p = 0.008) were independently related to a worse neonatal UA BE, while DDI was not significant (p = 0.53).
Conclusions. NeuraxA seems the preferential type of anesthesia during CR CS, because GenA is related to worse perinatal outcomes in terms of UA BE and neonatal reanimation and greater maternal blood loss.