Regional block versus general anaesthesia for caesarean section and neonatal outcomes: a population-based study

Charles S Algert,Warwick B Giles,Samantha J Lain,Greg E Knoblanche,Christine L Roberts,Jennifer R Bowen

doi:10.1186/1741-7015-7-20

Charles S Algert, Warwick B Giles + Show 4 more

Open Access

https://doi.org/10.1186/1741-7015-7-20

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Journal: BMC Medicine	Publication Date: Apr 29, 2009
Citations: 109	License type: cc-by

Affiliation: University of Sydney, Royal North Shore Hospital

Abstract

BackgroundAnaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia. However, general anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections.MethodsCohorts of caesarean sections by indication (that is, planned repeat caesarean section, failure to progress, foetal distress) were selected from the period 1998 to 2004 (N = 50,806). Deliveries performed under general anaesthesia were compared with those performed under spinal or epidural, for the outcomes of neonatal intubation and 5-minute Apgar (Apgar5) <7.ResultsThe risk of adverse outcomes was increased for caesarean sections under general anaesthesia for all three indications and across all levels of hospital. The relative risks were largest for low-risk planned repeat caesarean deliveries: resuscitation with intubation relative risk was 12.8 (95% confidence interval 7.6, 21.7), and Apgar5 <7 relative risk was 13.4 (95% confidence interval 9.2, 19.4). The largest absolute increase in risk was for unplanned caesareans due to foetal distress: there were five extra intubations per 100 deliveries and six extra Apgar5 <7 per 100 deliveries.ConclusionThe infants most affected by general anaesthesia were those already compromised in utero, as evidenced by foetal distress. The increased rate of adverse neonatal outcomes should be weighed up when general anaesthesia is under consideration.

Highlights

Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia
This study provides strong evidence that the guidelines recommending regional block over general anaesthesia (GA) for most caesarean sections (CS) are prudent and beneficial for neonates as well as for mothers [1,2]
Concerns about the effects of GA on the neonate have mostly focused on acid-base status, resuscitation and the Apgar score at 1 minute, with the presumption that the effect of GA on the infant is short lived [6]

Summary

Introduction

Anaesthesia guidelines recommend regional anaesthesia for most caesarean sections due to the risk of failed intubation and aspiration with general anaesthesia. General anaesthesia is considered to be safe for the foetus, based on limited evidence, and is still used for caesarean sections. Obstetric anaesthesia guidelines recommend spinal and epidural over general anaesthesia (GA) for most caesarean sections (CSs) [1,2]. The primary reason for recommending regional blocks is the risk of failed endotracheal intubation and aspiration of gastric contents in pregnant women who undergo GA [3]. Observational studies, generally unstratified by risk, are subject to confounding since emergencies such as an antepartum haemorrhage can be both an indication for GA and the cause of poor infant status at birth. That meta-analysis, and another which used cord blood acidbase status as the outcome [6], concluded that there was no evidence that regional anaesthesia was superior to GA in regard to neonatal outcomes

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