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Gulhane Med J. 2008; 50(2): 091-097


Comparison of the maternal and fetal effects of general and spinal anesthesia in elective cesarean section

Tarık Purtuloğlu, Sezai Özkan, Ertan Teksöz, Kamer Dere, Hüseyin Şen, Tamer Yen, Güner Dağlı.

Abstract
In our study we aimed to compare the maternal and fetal effects of two different anesthesia techniques (spinal and general) routinely performed in cases undergoing elective cesarean section. Fifty two cases undergoing elective cesarean section were divided into 2 groups. Spinal anesthesia was administered with 2-2.2 ml 0.5% bupivacaine at the L3-4 and L4-5 interspaces in the lateral position in cases in Group I (n=26). In cases in Group II (n=26), anesthesia induction was made with 2 mg/kg propofol and 0.6 mg/kg rocuronium. Fifty percent O2 + 50% N2O and sevoflurane were used for the maintenance of anesthesia. Maternal hemodynamic parameters (heart rate, mean arterial blood pressure) were recorded in both groups at every five minutes during 45 minutes after the initiation of anesthesia, and 6 ml of umbilical artery blood sample was taken from all the cases following delivery. Blood gases analysis, ALT, AST, creatin kinase and total cortisol levels were studied in the blood samples. Evaluation of the newborn was performed by a pediatrician, and APGAR scores at the first and 5th minutes were recorded. In our study, results of APGAR scores, fetal blood gases (pH, pO2, pCO2, HCO2-, BE), creatin kinase and ALT levels, and maternal mean arterial blood pressure and heart rate values were similar in both groups. Although fetal AST and total cortisol levels were higher in Group II, these values were within normal ranges in both groups. We conclude that the two anesthesia techniques administered in elective cesarean sections are not superior to each other in terms of maternal hemodynamic parameters and fetal well-being. Choice of anesthetic technique which will be used should be made on the basis of advantages and disadvantages of both techniques, comorbidities present in the patient, urgency of the operation, experience of the anesthesiologist and patient's choice.

Key words: Fetal well-being, general anesthesia, maternal effect, cesarean section, spinal anesthesia



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