Perioperative morbidity and mortality and neonatal outcomes in patients undergoing cesarean section with spinal anesthesia versus general anesthesia in Vachira Phuket hospital
Keywords:
cesarean section, spinal block, general anesthesia, perioperative maternal complication, neonatal outcomeAbstract
Background: Spinal block (SB) and general anesthesia (GA) are commonly used for cesarean section (CS) and both have advantages and disadvantages. Physiologic change related to anesthesia cause difference perioperative complications. Objectives: To compare perioperative maternal morbidity,
mortality and neonatal outcomes of 2 anesthetic techniques. Methods:After approval of local ethic committee, retrospectively reviewed anesthetic records of 200 patients who received SB (n=100) and GA (n=100) for CS, data collection included maternal demographics, anesthetic techniques and perioperative
complications. Chi-square and T-test, Odds ratio and 95% CI were used to compare difference between 2 groups, p-value < 0.05 was considered significant.Results: There were no difference between 2 groups in term of demographics, operative time and gestational age. Incidence of hypotension in SB was 68%. Compared with GA, SB had more hypotension (OR=104.13, 95%CI 24.39-500), more nausea (OR=2.09, 95%CI 1.8-2.42) and more pruritus (OR=2.43,
95%CI 2.03-2.91). GA had more hypertension (OR=62.36, 95%CI 14.56-267), needed more analgesic drug in RR (OR=2.54, 95%CI 2.11-3.07) and more newborn with Apgar 1 minute ≤ 7 (OR=3.5, 95%CI 1.59-7.68). No serious maternal and neonatal complication in 2 groups.Conclusions:Compare with GA, SB had more
hypotension, nausea and pruritus. GA had more hypertension, needed analgesic drug in RR and newborn with Apgar 1 minute ≤7. Closed monitoring and prevention of complications should be concerned in clinical practice.
References
Andre P. Schmidt, Jose Otavio C, Auler Jr.Evidence-Based Obstetric Anesthesia: An Update on Anesthesia for Cesarean Delivery [online]. Available from: http://www.intechopen. com/books/cesarean-delivery/evidence-basedobstetric- anesthesia-an-upate-on-anesthesiafor- cesarean-delivery.[cited 2016 March 8].
Morgan GE, Mikhail MS, Murray MJ, Larson CP. Maternal and Fetal Physiology and Anesthesia. In: Morgan GE, Mikhail MS, Murray MJ, Larson CP, editors. Clinical Anesthesiology. 3rd ed. New york: McGraw-Hill; 2002: 804-18.
Jenkins G, Khan M. Anesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003; 58:1114-18.
Ashok J. Complication of regional and general anesthesia in obstetric practice. Indian J Anaesth 2010;54(5): 415-20.
Bromage PR. Neurologic Complications of Regional Anaesthesia for Obstetrics. In: HughesSC, Levinson G, Rosen MA, editors. Shnider and Levinson’s anesthesia for obstetrics.4thed. USA: Lippincott Williams and Wilkins Philadelphia; 2002. p.409-16.
Giovani de Figueiredo L. Incidence of shivering after cesarean section under spinal anesthesia with or without intrathecal sufentanil: a randomized study. Rev Bras Anestesiol 2012; 62(5).
Mitra J, Azim H, Mohammadreza S, Mohsen C. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded comparison of midazolam, ondansetron and a combination. Adv Biomed Res 2012; 1:2.doi: 10.4103/2277-9175. 94424.
Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003: 50: 460-9.
Spencer HC. Postdural puncture headache: what matters in technique? Reg Anesth Pain Med 1998; 23: 374-9.
Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med Assoc Thai 2008; 91(2): 181-7.
Chumpathong S, Chinachoti T, Visalyaputra S, Himmunngan T. Incidence and risk factors of hypotension during spinal anesthesia for cesarean section at Siriraj Hospital. J Med Assoc Thai 2006; 89(8): 1127-32.
Djabatey EA, Barclay PM. Difficult and failed intubation in 3430 obstetric general anaesthetics. Anaesthesia 2009; 69: 1168-71.
Afolabi BB, Lesi FEA, Merah NA. Regional versus general anaesthesia for caesarean section (Review). Cochrane Database of Systematic Reviews 2006; 4. doi: 10.1002/14651858.CD004350.pub2.
Charles SA, Jennifer RB, Warwick BG, Greg EK, Samantha JL, Christine LR. Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study. BMC Med 2009; 7:20. doi:10.1186/1741-7015-7- 20.
John Jairo PL, José Ricardo N. Regional versus general anesthesia for cesarean delivery. RevCol Anesth 2012; 40(3): 203-6. doi: 10.1016/j. rcae.2012.06.001.
Mai WA, Nashwa SE, Mohamed MA, Ahmed Ali MG. A comparative study of general anesthesia versus combined spinal-epidural anesthesia on the fetus in cesarean section. Egyptian Journal of Anaesthesia 2014; 30: 155-60.
Qublan HS, Merhej A, Dabbas MA, Hindawi IM. Spinal versus general anesthesia for elective cesarean delivery: a prospective comparative study. Clin Exp Obstet Gynecol 2001; 28(4): 246-8.
Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2012; 17:10. doi:10.1002/ 14651858.CD004350.pub3.
Caplan RA, Ward RJ, Posner K, Cheney FW. Unexpected cardiac arrest during spinal anesthesia: a closed claims analysis of predisposing factors. Anesthesiology 1998; 68:5-11.
Watkins EJ, Dresner M, Calow CW. Severe vasovagal attack during regional anaesthesia for caesarean section. Br J Anaesth 2000; 84: 118-20.
Klauser CK, Fox NS, Istwan N, Rhea D, Rebarber A, Desch C, et al. Treatment of severs nausea and vomiting of pregnancy with subcutaneous medications. Am J Perinatol 2011; 28: 715-21.
Palanisamy A, Mitani AA, Tsen LC. General anesthesia for cesarean delivery at a tertiary care hospital from 2000 to 2005: a retrospective analysis and 10-year update. Int J Obstet Anesth 2011;20:10–6.
Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979–2002. Obstet Gynecol 2011;117:69–74.
Hong JY, Jee YS, Yoon HJ, Kim SM. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal
hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth 2003;12: 12–6.
Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James MF. Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. Anesthesiology 2003;99:561–9.
Kamal K, Sudha Indu S. Neuraxial opioid-induced pruritus: An update. J Anaesthesiol Clin Pharmacol 2013; 29 (3) 303-7.
Szarvas S, Harmon D, Murphy D. Neuraxial opioidinduced pruritus: A review. J Clin Anesth 2003; 15: 234–9.
Yeh HM, Chen LK, Lin CJ, Chan WH, Chen YP, Lin CS, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine- induced pruritus in patients undergoing cesarean delivery. Anesth Analg 2000; 91: 172–5.
Mancuso A, De Vivo A, Giacobbe A, Priola V, Maggio Savasta L, Guzzo M, De Vivo D, Mancuso A. 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: 1114–8.
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: 311–4.
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: 40–5.
Kavak ZN, Basgu¨l 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;1(100):50–4.
Maghsoudloo M, Eftekhar N, Ashraf M, Khan H,et al. Does intravenous fentanyl affect apgar scores and umbilical vessel blood gas parameters in cesarean section under general anesthesia? Acta Medica Iranica 2011; 49(8): 517–22.
Morgan GE, Mikhail MS, Murray MJ, Larson CP. Maternal and Fetal Physiology and Anesthesia. In: Morgan GE, Mikhail MS, Murray MJ, Larson CP, editors. Clinical Anesthesiology. 3rd ed. New york: McGraw-Hill; 2002: 804-18.
Jenkins G, Khan M. Anesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia 2003; 58:1114-18.
Ashok J. Complication of regional and general anesthesia in obstetric practice. Indian J Anaesth 2010;54(5): 415-20.
Bromage PR. Neurologic Complications of Regional Anaesthesia for Obstetrics. In: HughesSC, Levinson G, Rosen MA, editors. Shnider and Levinson’s anesthesia for obstetrics.4thed. USA: Lippincott Williams and Wilkins Philadelphia; 2002. p.409-16.
Giovani de Figueiredo L. Incidence of shivering after cesarean section under spinal anesthesia with or without intrathecal sufentanil: a randomized study. Rev Bras Anestesiol 2012; 62(5).
Mitra J, Azim H, Mohammadreza S, Mohsen C. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded comparison of midazolam, ondansetron and a combination. Adv Biomed Res 2012; 1:2.doi: 10.4103/2277-9175. 94424.
Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003: 50: 460-9.
Spencer HC. Postdural puncture headache: what matters in technique? Reg Anesth Pain Med 1998; 23: 374-9.
Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med Assoc Thai 2008; 91(2): 181-7.
Chumpathong S, Chinachoti T, Visalyaputra S, Himmunngan T. Incidence and risk factors of hypotension during spinal anesthesia for cesarean section at Siriraj Hospital. J Med Assoc Thai 2006; 89(8): 1127-32.
Djabatey EA, Barclay PM. Difficult and failed intubation in 3430 obstetric general anaesthetics. Anaesthesia 2009; 69: 1168-71.
Afolabi BB, Lesi FEA, Merah NA. Regional versus general anaesthesia for caesarean section (Review). Cochrane Database of Systematic Reviews 2006; 4. doi: 10.1002/14651858.CD004350.pub2.
Charles SA, Jennifer RB, Warwick BG, Greg EK, Samantha JL, Christine LR. Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study. BMC Med 2009; 7:20. doi:10.1186/1741-7015-7- 20.
John Jairo PL, José Ricardo N. Regional versus general anesthesia for cesarean delivery. RevCol Anesth 2012; 40(3): 203-6. doi: 10.1016/j. rcae.2012.06.001.
Mai WA, Nashwa SE, Mohamed MA, Ahmed Ali MG. A comparative study of general anesthesia versus combined spinal-epidural anesthesia on the fetus in cesarean section. Egyptian Journal of Anaesthesia 2014; 30: 155-60.
Qublan HS, Merhej A, Dabbas MA, Hindawi IM. Spinal versus general anesthesia for elective cesarean delivery: a prospective comparative study. Clin Exp Obstet Gynecol 2001; 28(4): 246-8.
Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2012; 17:10. doi:10.1002/ 14651858.CD004350.pub3.
Caplan RA, Ward RJ, Posner K, Cheney FW. Unexpected cardiac arrest during spinal anesthesia: a closed claims analysis of predisposing factors. Anesthesiology 1998; 68:5-11.
Watkins EJ, Dresner M, Calow CW. Severe vasovagal attack during regional anaesthesia for caesarean section. Br J Anaesth 2000; 84: 118-20.
Klauser CK, Fox NS, Istwan N, Rhea D, Rebarber A, Desch C, et al. Treatment of severs nausea and vomiting of pregnancy with subcutaneous medications. Am J Perinatol 2011; 28: 715-21.
Palanisamy A, Mitani AA, Tsen LC. General anesthesia for cesarean delivery at a tertiary care hospital from 2000 to 2005: a retrospective analysis and 10-year update. Int J Obstet Anesth 2011;20:10–6.
Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979–2002. Obstet Gynecol 2011;117:69–74.
Hong JY, Jee YS, Yoon HJ, Kim SM. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal
hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth 2003;12: 12–6.
Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James MF. Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. Anesthesiology 2003;99:561–9.
Kamal K, Sudha Indu S. Neuraxial opioid-induced pruritus: An update. J Anaesthesiol Clin Pharmacol 2013; 29 (3) 303-7.
Szarvas S, Harmon D, Murphy D. Neuraxial opioidinduced pruritus: A review. J Clin Anesth 2003; 15: 234–9.
Yeh HM, Chen LK, Lin CJ, Chan WH, Chen YP, Lin CS, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine- induced pruritus in patients undergoing cesarean delivery. Anesth Analg 2000; 91: 172–5.
Mancuso A, De Vivo A, Giacobbe A, Priola V, Maggio Savasta L, Guzzo M, De Vivo D, Mancuso A. 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: 1114–8.
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: 311–4.
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: 40–5.
Kavak ZN, Basgu¨l 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;1(100):50–4.
Maghsoudloo M, Eftekhar N, Ashraf M, Khan H,et al. Does intravenous fentanyl affect apgar scores and umbilical vessel blood gas parameters in cesarean section under general anesthesia? Acta Medica Iranica 2011; 49(8): 517–22.
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Published
2017-03-01
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เอื้อกฤดาธิการ ธ. (2017). Perioperative morbidity and mortality and neonatal outcomes in patients undergoing cesarean section with spinal anesthesia versus general anesthesia in Vachira Phuket hospital. Region 11 Medical Journal, 31(1), 15–26. Retrieved from https://he02.tci-thaijo.org/index.php/Reg11MedJ/article/view/159404
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