Comparison of the Process and Outcome of Spinal Anaesthesia and General (Ether) anaesthesia for caesarean section in Mulago Hospital

ABSTRACT

Objective: To compare the process and outcome of Spinal Anaesthesia (SA) with that of General Anaesthesia (GA) for Cesarean Section (c/s). The study was prompted by the current virtually exclusive utilization; but unacceptable standard and safety of GA in Mulago Hospital. There is also a wide knowledge gap on implications of the use of both GA and SA in general; but as applied to our setting in particular. Setting: Mulago Hospital Obstetrics and Gynaecology Theatre and all Obstetrics wards. Methods: This was a prospective randomised; unblinded clinical trial in which 142 ASA physical status 1 and 2 mothers at term scheduled for c/s and gave written consent to take part in the study were randomly allocated to receive one of the two techniques (SA/GA). the intra-operative course using the induction time; surgeons waiting time and total anaesthesia time; adequacy of anaesthesia intra-operative blood loss and the mean falls of blood pressure were comapred. The outcome was done using the Apgar Scores of the delivered babies; associated complications; rating of the technique by the Anaesthesists/surgeon/mother and the final outcome of the mother plus her baby. The mean cost of the drugs and materials used for the anaesthetic was also compared. The Arcus statistical soft ware was used for analysis; statistical significance was achieved at p0.05. Results: For c/s where mother and fetus are normal in Mulago hospital; SA compared to GA was associated with similar operating conditions (97.2) as compared to 95.8 had good operative conditions) and fetal outcome (pns); lower blood loss (550+- 112.4 comapred to 802+-126.4) mls; less undesired intra and post operative sequalae. It was cheaper (US$14.26 +-3.8 comapred to 37.14 +-2.9); enabled earlier return to independent living conditions and was highly appreciated by the mothers. However it had a longer preparation time (p0.0001) and bigger drop in BP (13+-7.7 compared to 8 +-7.9) mmHG