Comparing the Effect of Spinal and General Anaesthesia for Pre-Eclamptic Mothers Who Underwent Caesarean Delivery in A Tertiary, Addis Ababa, Ethiopia

A Five-Year Retrospective Closed Cohort Study to Find a Superior Anaesthetic Technique for Caesarean Section From a Haemodynamic Perspective

Background A cesarean section (CS) is common and requires a safe and effective anesthetic technique for the safety of both the mother and the fetus. This study aims to compare the intraoperative hemodynamic safety profile with general anesthesia (GA) and regional anesthesia (RA) and propose a superior technique for cesarean from the hemodynamic perspective. Methods After obtaining ethical committee approval, a retrospective closed cohort study was conducted on patients who underwent cesarean with GA and RA. This study was conducted at a tertiary-level university hospital in Oman from January 2015 to December 2019. The investigators collected maternal and fetal data (hypotension, bradycardia, blood loss, APGAR score, fetal mortality, complications, and length of stay) from January 2015 to December 2019. The primary outcome was the incidence of intraoperative hypotension, and the secondary outcomes studied were significant blood loss and APGAR score in both anesthesia techniques. Results A total of 2500 cesarean patients were studied, of whom 1379 received RA and 1121 received GA. The overall hypotension (systolic BP<90 mm Hg) rate observed was 40.1%; it was significantly lower with GA as compared to RA (32.1% versus 46.5%, respectively, P<0.001, OR 0.545, 95% CI 0.462 to 0.643). Consequently, the requirement for vasopressors was low with GA compared to RA (1.6% versus 23.1%, P<0.001, OR 0.054, 95% CI 0.034 to 0.088). Blood loss (>1 L) was remarkably higher in GA as compared to the RA (15.5% versus 8.9%, respectively, P<0.001, OR 1.916, 95% CI 1.499 to 2.448). APGAR scores were lower with GA than RA (2.8% versus 0.9%, P<0.001). Bradycardia and fetal mortality were almost equal in both groups. Conclusion GA is associated with significantly better hemodynamic stability during the cesarean section.

Comparison of hemodynamic changes and fetal outcome between normotensive and preeclamptic parturient undergoing elective cesarean section under spinal anesthesia: A prospective observational cohort study

Background

Objective

Methodology

Results

Conclusion

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Peak sensory block level was similar in both groups and no patients complained intraoperative pain and analgesics were not required supplemental.

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Base line SBP, DBP and MAP were significantly higher in severe preeclamptic group (p = 0.01).

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Mean gestational age of the fetus was significantly low in severe preeclamptic group (p = 0.01).

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Apgar score at 1st min(7–8 vs,8–9),volume of intra operative fluid use were statistically significant with p < 0.05

Comparison of Effects of General Anesthesia and Combined Spinal/Epidural Anesthesia for Cesarean Delivery on Umbilical Cord Blood Gas Values: A Double-Blind, Randomized, Controlled Study

BACKGROUND The objective of this study was to analyze the effects of general anesthesia in cesarean section on the umbilical cord blood gas values and intraoperative hemodynamics of parturient women. MATERIAL AND METHODS A total of 112 parturient women who received cesarean section were eventually randomized into 2 groups, GA (general anesthesia) group (n=56), and SE (combined spinal and epidural anesthesia) group (n=56). The umbilical cord blood gas values, postpartum Apgar score, intraoperative blood loss, mean arterial pressure, heart rate, total operative time, time intervals from anesthesia to delivery and from skin incision to delivery, the incidences of adverse reactions and neonatal asphyxia, and the postoperative patient satisfaction were compared between the 2 groups. RESULTS There were no significant differences between the 2 groups in total operative time, Apgar score, neonatal asphyxia rate, umbilical arterial and venous cord blood gas values, intraoperative blood loss, and time interval from skin incision to delivery (all P˃0.05). The GA group was significantly shorter in the time interval from anesthesia to delivery than the SE group (P˂0.05). The incidences of nausea, vomiting, and chills in the GA group were significantly lower than those in the SE group (all P˂0.05). The GA group was significantly higher in postoperative patient satisfaction than the SE group (P˂0.05). CONCLUSIONS General anesthesia has little impact on the umbilical cord blood gas values and Apgar score, and ensures better hemodynamic stability in cesarean section. Moreover, general anesthesia is characterized by rapid induction and is therefore valuable for use in clinical procedures.