Does the Type of Anesthesia for Caesarean Section Affect the Neonate? A Non- Randomized Observational Study Comparing Spinal versus General Anesthesia

The influences on neonates due to choice of anesthesia for cesarean section deliveries, general versus spinal were the focus of this prospective non randomized observational study. Aims and objectives: To study the effects of choice of obstetric anesthesia during Cesarean Section (General (GA) or spinal (SA): on mothers by assessing Mean arterial Blood pressure changes and Time to delivery from initiation of Anesthesia, & Uterine Incision: on neonates by assessing Apgar Scores and Umbilical cord blood parameters. Material and methods: Two groups of 20 expectant mothers each, posted for elective caesarean sections ASA 1 & 2. Group A: SA Group B: GA. Informed consent, IERB approval, Results: The two groups were comparable in terms of age, weight, pre-operative mean arterial pressure and gravid status. The mean speed of surgery in minutes was significantly faster under General Anesthesia (8.65 to 17.6) when measured from induction of anesthesia to delivery time, and (1.65 to 2.4) when measured from uterine incision to delivery time. The upper limit of block of spinal anesthesia was variable, but mostly centered around T4, T6. The maximum values of Fluctuations in the Blood pressure in the two groups showed that the SA group had a drop in the mean arterial pressure up to 54 mmHg, while the GA group showed a rise in the mean arterial pressure up to 107 mmHg. The neonatal cord blood parameters across the two groups showed no significant differences in pH, PCO2, HCO3, and base excess. However umbilical cord venous blood oxygenation (35.86) and Oxygen saturation (58.71) were significantly better when delivery was under GA in comparison with SA (26.59 and 44.58). Discussion: The benefits of a faster surgical time achieved under General anesthesia were not quantifiable as no difference in apgar score in the neonates of the two groups at 1 or 5 minute. The fluctuations in Blood pressure likewise did not translate to evidence of fetal hypoxia. The increased blood oxygenation as a consequence of controlled anesthesia was the only noteworthy finding in the cord blood analysis. Conclusion: There were no statistically significant changes on the apgar score of neonates or their blood biochemistry, if the choice of anesthesia for cesarean section were general or spinal. Cord blood oxygenation was higher with general anesthesia.