Effect of various techniques of Anesthesia in elective Caesarian section on short term Neonatal outcome
Abstract
Introduction: The basic aim of obstetric anesthesia is to provide adequate maternal pain relief with no deleterious effect on mother and newborn. This study aimed to assess the effect of spinal anesthesia, epidural anesthesia and general anesthesia using thiopentone sodium as induction agent on neonates delivered after elective caesarian section.
Materials and methods: This is a prospective descriptive study at a tertiary care teaching hospital from June 2013 to May 2014. 60 cases of elective caesarian section admitted in Department of Obstetrics and Gynecology were studied. Patients were randomly divided into 3 groups each of 20 cases. Group 1 received spinal anesthesia, group 2 epidural anesthesia and group 3 general anesthesia. Neonatal outcome was assessed in relation to anesthetic techniques used.
Results: The mean Apgar score at 1 min was lower in GA group (7 +/- 1.025) than in spinal anesthesia group (8.1+/- 0.78) and epidural anesthesia group (8.35 +/- 0.745). Total 3/60 (5%) neonates required resuscitation at birth all of which were in GA group. Induction delivery interval of < 5 min and > 20 min was associated with need for resuscitation at birth. Moderate depression of neonates (1 min Apgar score of 4-6) was observed in 2/20 (10%) neonates in group 3.
Conclusion: Neonates born by elective LSCS under GA have lower 1 min Apgar scores. Induction delivery interval of < 5 min and > 20 min is associated with need for resuscitation at birth in neonates in GA group. These effects can be minimized by maintaining the ID interval between 5 – 15 minutes.
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References
2. Meikle SF, Steiner CA, Zhang J, Lawrence WL. A national estimate of the elective primary cesarean delivery rate. Obstet Gynecol 2005; 105: 751-756. [PubMed]
3. Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2006 Oct; 18(4):CD004350.
4. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, Hazinski MF, Halamek LP, Kumar P, Little G, McGowan JE, Nightengale B, Ramirez MM, Ringer S, Simon WM, Weiner GM, Wyckoff M, Zaichkin J. Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2010 Nov; 126(5):1400-13.
5. Hughes SC, Levinson G, Rosen MA, Shnider SM. Shnider and Levinson’s Anesthesia for Obstetrics.4th ed.Philadelphia: Lippincott Williams & Wilkins; 2002.
6. Mancuso A, De Vivo A, Giacobbe A, Priola V, Maggio Savasta L, Guzzo M, De Vivo D. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomized study. J Matern Fetal Neonatal Med 2010 Oct; 23(10):1114-8.
7. Kolatat T, Somboonnanonda A, Lertakyamanee J, Chinachot T, Tritrakarn T, Muangkasem J. Effects of general and regional anesthesia on the neonate (a prospective, randomized trial). J Med Assoc Thai 1999; 82: 40-45.
8. Yegin A, Ertug Z, Yilmaz M, Erman M. The effects of epidural anesthesia and general anesthesia on newborns at cesarean section. Turk J Med Sci 2003; 33: 311-314.
9. Kavak ZN, Basgul 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: 50-54.
10. Krishnan L, Gunasekaran N, Bhasaranand N. Anesthesia for Cesarean section and immediate neonatal outcome. Indian J Pediatr 1995 Mar-Apr; 62(2):219-23. [PubMed]
11. Roberets SW, Leveno KJ, Sidawi JE, Lucas MJ, Kelly MA. Fetal acidemia associated with regional anaesthesia for elective cesarean delivery. Obstet Gynecol 1995; 85:79-83. [PubMed]
12. Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G. Spinal and epidural versus general anaesthesia for elective cesarean section at term: effect on the acid base status of the mother and newborn. J Matern Fetal Neonatal Med.2003 Apr; 13 (4):260-6.
13. Finster M, Mark LC, Morishima HO, Moya F, Perel JM, James LS, Dayton PG. Plasma thiopentone concentration in newborn following delivery under thiopentone – nitrous oxide anaesthesia. Am J Obstet Gynecol 1967 June; 95: 621-29.
14. Kamat SK, Shah MV, Chaudhary LS, Pandya S, Bhatt MM. Effect of induction-delivery and uterine-delivery on Apgar scoring of the newborn. J Postgrad Med. 1991 Jul; 37(3):125-7. [PubMed]
15. Dutta S, Ostheimer GW, Weiss JB. Neonatal effect of prolonged induction for cesarean section. Obstet Gynecol 1981; 58:331-5. [PubMed]
16. Morgan GE, Mikhail MS, Murray MJ. Clinical Anaesthesiology. 6th ed. New York: Lange medical books/McGraw Hill Medical Pub division; 2006.
17. Li CH, Zhu CX, He J. Effects of general anesthesia for cesarean section on infants. Zhonghua Fu Chan Ke Za Zhi 2006 Mar; 41(3):162-4. [PubMed]
18. Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section.Gynecol Obstet Invest 2003; 55(1):41-5.
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