Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia
a randomized clinical trial
Keywords:
Cesarean section, Anesthesia, general, Hemoglobins, Hematocrit, Anesthesia, spinalAbstract
CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section. DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital. METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups. RESULTS: Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group. CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account. CLINICAL TRIAL REGISTRY: NTR17990
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Gori F, Pasqualucci A, Corradetti F, Milli M, Peduto VA. Maternal and neonatal outcome after cesarean section: the impact of anesthesia. J Matern Fetal Neonatal Med. 2007;20(1):53-7.
Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455-60.
Ronsmans C, Graham WJ; Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189-200.
Tsen LC. Anesthesia for cesarean section. In: Chestnut DH, Polley LS, Wong CA, Tsen LC, editors. Chestnut’s obstetric anesthesia: principles and practice. 4th ed. Philadelphia: Elsevier Mosby; 2009. p. 521-51.
Cooper MG, McClure JH. Anaesthesia. In: Lewis G, Drife J, editors. Why mothers die 2000-2002. Confidential enquiries into maternal and child health. Improving care for mothers, babies and children. London: RCOG Press; 2004. p. 122-33.
Ngan Kee WD. Confidential enquiries into maternal deaths: 50 years of closing the loop. Br J Anaesth. 2005;94(4):413-6.
Reynolds F. General anesthesia is unacceptable for elective cesarean section. Int J Obstet Anesth. 2010;19(2):212-7.
Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103(3):645-53.
Kavak ZN, Başgül A, Ceyhan N. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section. A prospective randomized study. Eur J Obstet Gynecol Reprod Biol. 2001;100(1):50-4.
Mattingly JE, D’Alessio J, Ramanathan J. Effects of obstetric analgesics and anesthetics on the neonate: a review. Paediatr Drugs. 2003;5(9):615-27.
Littleford J. Effects on the fetus and newborn of maternal analgesia and anesthesia: a review. Can J Anaesth. 2004;51(6):586-609.
Richardson MG. Regional anesthesia for obstetrics. Anesthesiol Clin North America. 2000;18(2):383-406.
Laudenbach V, Mercier FJ, Rozé JC, et al. Anaesthesia mode for caesarean section and mortality in very preterm infants: an epidemiologic study in the EPIPAGE cohort. Int J Obstet Anesth. 2009;18(2):142-9.
Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth. 2008;17(4):329-35.
Bloom SL, Spong CY, Weiner SJ, et al. Complications of anesthesia for cesarean delivery. Obstet Gynecol. 2005;106(2):281-7.
Kolås T, Saugstad OD, Daltveit AK, Nilsen ST, Øian P. Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol. 2006;195(6):1538-43.
Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia. 2003;58(11):1114-8.
Gogarten W. Spinal anaesthesia for obstetrics. Best Pract Res Clin Anaesthesiol. 2003;17(3):377-92.
Ng K, Parsons J, Cyna AM, Middleton P. Spinal versus epidural anaesthesia for caesarean section. Cochrane Database Syst Rev. 2004;(2):CD003765.
Hawkins JL. Obstetric analgesia and anesthesia. In: Gibbs RS, Karlan BY, Haney AF, Nygaard I, editors. Danforth’s obstetrics and gynecology. 10th edition. Philadelphia: Lippincott, Williams & Wilkins; 2010. p. 43-59.
Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54(8):909-21.
Maayan-Metzger A, Schushan-Eisen I, Todris L, Etchin A, Kuint J. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol. 2010;202(1):56.e1-5.
Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol. 2010;23(3):304-9.
Shin BS, Ko JS, Gwak MS, et al. The effects of prehydration on the properties of cerebrospinal fluid and the spread of isobaric spinal anesthetic drug. Anesth Analg. 2008;106(3):1002-7.
Harten JM, Boyne I, Hannah P, Varveris D, Brown A. Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section. Anaesthesia. 2005;60(4):348-53.
Hallworth SP, Fernando R, Columb MO, Stocks GM. The effect of posture and baricity on the spread of intrathecal bupivacaine for elective cesarean delivery. Anesth Analg. 2005;100(4):1159-65.
Desalu I, Kushimo OT. Is ephedrine infusion more effective at preventing hypotension than traditional prehydration during spinal anaesthesia for caesarean section in African parturients? Int J Obstet Anesth. 2005;14(4):294-9.
Macarthur A, Riley ET. Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin. 2007;45(1):115-32.
Lin FQ, Qiu MT, Ding XX, Fu SK, Li Q. Ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean section: an updated meta-analysis. CNS Neurosci Ther. 2012;18(7):591-7.
Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. Can J Anaesth. 2012;59(6):604-19.
Cooper DW. Caesarean delivery vasopressor management. Curr Opin Anaesthesiol. 2012;25(3):300-8.
Oh AY, Hwang JW, Song IA, et al. Influence of timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload. BMC Anesthesiol. 2014;14:36.
Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;(4):CD004350.
Park GE, Hauch MA, Curlin F, Datta S, Bader AM. The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure. Anesth Analg. 1996;83(2):299-303.
Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput. 2007;21(2):125-9.
Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012;10:CD004350.
Mancuso A, De Vivo A, Giacobbe A, et al. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. J Matern Fetal Neonatal Med. 2010;23(10):1114-8.
Martin TC, Bell P, Ogunbiyi O. Comparison of general anaesthesia and spinal anaesthesia for caesarean section in Antigua and Barbuda. West Indian Med J. 2007;56(4):330-3.
Wong CA. General anesthesia is unacceptable for elective cesarean section. Int J Obstet Anesth. 2010;19(2):209-12.
Havas F, Orhan Sungur M, Yenigün Y, et al. Spinal anesthesia for elective cesarean section is associated with shorter hospital stay compared to general anesthesia. Agri. 2013;25(2):55-63.
