Effect of Spinal Anesthesia versus General Anesthesia on Blood Glucose Concentration in Patients Undergoing Elective Cesarean Section Surgery: A Prospective Comparative Study.

Khaled El-Radaideh,Haitham Odat,Ala’’A Alhowary,Mohammad Alsawalmeh,Ahmed Abokmael,Amer Sindiani

doi:10.1155/2019/7585043

Abstract

Background This prospective study compared the blood glucose concentration with spinal anesthesia or general anesthesia in patients undergoing elective cesarean section surgery. Methods In total, 58 pregnant women who underwent elective cesarean section surgery were included in this prospective comparative study. Group S (n = 35) included patients who chose spinal anesthesia, and group G (n = 23) included patients who chose general anesthesia. The patients were allocated to the groups upon patients' preference. For the group G, the blood glucose concentration (BGC) was obtained 5 minutes before induction, T1, and 5 minutes after induction T2. For the group S, the BGC was obtained immediately before the injection of the local anesthetic agent T1 and 5 minutes after the complete block T2. For both groups, BGC was measured 5 minutes before the end of surgery T3 and 30 minutes after the end of surgery T4. For BGC measurements, we used a blood glucose monitoring system with a lancet device to prick the finger. Results There was no statistically significant difference in the mean blood glucose concentration between the groups S and G in T1 (78.3 ± 18.2 vs. 74.3 ± 14.7, p > 0.05) and T2 (79.2 ± 18.3 vs. 84.9 ± 23.7, p > 0.05). The mean BGC was statistically significantly higher in group G in comparison to group S in the times 5 minutes before (80.2 ± 18.1 vs. 108.4 ± 16.7, p < 0.05) and 30 minutes after the end of surgery (80.9 ± 17.7 vs. 121.1 ± 17.4, p < 0.05). Conclusion There is a much lower increase in blood glucose concentration under spinal anesthesia than under general anesthesia. It is reasonable to suggest that the blood sugar concentration must be intraoperatively monitored in patients undergoing general anesthesia.

Highlights

Spinal anesthesia has become the preferred anesthetic technique when providing anesthesia for patients undergoing elective cesarean section as the risk of maternal and fetal complications associated with spinal anesthesia is less than with general anesthesia [1,2,3,4,5]
Every surgical procedure is associated with a stress response which comprises a number of endocrine, metabolic, and immunological changes triggered by neuronal activation of the hypothalamic-pituitary-adrenal axis [6, 7]. e overall metabolic effect of the stress response to surgery includes an increase in secretion of catabolic hormones, such as cortisol and catecholamine, and a decrease in secretion of anabolic hormones, such as insulin and testosterone. e increase in levels of catabolic hormones in plasma stimulates glucose production, and there is a relative lack of insulin together with impaired tissue insulin sensitivity and glucose
The stress response is activated by afferent neural activity from the site of trauma. ese afferent neurons travel along sensory nerve roots through the dorsal root of the spinal cord up the spinal cord to the medulla to activate the hypothalamus

Summary

Introduction

Spinal anesthesia has become the preferred anesthetic technique when providing anesthesia for patients undergoing elective cesarean section as the risk of maternal and fetal complications associated with spinal anesthesia is less than with general anesthesia [1,2,3,4,5]. E hyperglycemic response to surgical stresses in the perioperative period may harm patients since it is an independent risk factor associated with adverse outcomes such as impaired wound healing and an increased risk of wound infection [7, 9, 10]. Ese afferent neurons travel along sensory nerve roots through the dorsal root of the spinal cord up the spinal cord to the medulla to activate the hypothalamus. Neuraxial anesthesia such as epidural or spinal anesthesia blocks afferent neural impulses; the stress response to surgery including hyperglycemia is inhibited [6, 7, 14, 15]. We tested the hypothesis that spinal anesthesia would result in a less-pronounced stress-induced hyperglycemia than general anesthesia during cesarean sections in nondiabetic patients

Materials and Methods

Ethical Approval

Findings

Disclosure