Comparison of general and regional anesthesia for cesarean section: success rate, blood loss and satisfaction from a randomized trial.

OBJECTIVE: A prospective randomized trial was organized to compare the effectiveness of general and regional anesthesia for cesarean section (C/S). METHOD: Three hundred and forty-one patients were randomized into the general anesthesia group (GA), epidural anesthesia group (EA) and spinal anesthesia group (SA). The effectiveness of interest was success rate, blood loss and patient satisfaction. RESULT: We found that the success rates of EA and SA were lower than GA. Success in EA should be improved by using an epidural catheter to add more local anesthetic drug instead of a single shot; and the surgeon should allow more time for the block to work adequately. Success in SA should be improved by using bupivacaine instead of lidocaine. GA resulted in significantly more blood loss, lower postoperative hematocrit, and higher proportion of patients who had postoperative hematocrit < 30 per cent than EA and SA. The patients' satisfaction scores were not different among the 3 techniques. This meant that, given adequate explanation and perioperative care, Thai women were satisfied with regional anesthesia. CONCLUSION: Regional anesthesia is a better choice of anesthesia for C/S than general anesthesia. However, the availability of different techniques and ability to change the technique when needed were very useful and important. If GA is chosen, all safety procedures must be followed. Oxygen supplement and endotracheal intubation facilities must be available in all techniques. Guidelines of anesthesia for C/S at a national level should be agreed upon, including the type of personnel, monitoring equipment and postoperative care.

Effects of general and regional anesthesia on the neonate (a prospective, randomized trial).

Anesthetic methods used during cesarean section have advantages and disadvantages to both mothers and infants and may result in short and long term neonatal effects. OBJECTIVE: To determine the effects of general and regional anesthesia on the infants, a prospective, randomized trial was performed in Siriraj Hospital, Mahidol University. MATERIAL AND METHOD: 341 uncomplicated pregnant women who were to be delivered at term by Cesarean section were recruited and randomized to receive general anesthesia, GA (103); epidural anesthesia, EA (120) and spinal anesthesia, SA (118). The immediate fetal and neonatal effects were assessed by cord blood gas analysis and the infant's Apgar scores. The Neurologic and Adaptive Capacity Scores (NACS) was performed within 4 hours after birth by two pediatricians who were blind to the anesthetic method. RESULT: Maternal age, weight, height, duration of the operation and infants' birth weight were not different among the study groups. In the EA and SA group, maternal systolic blood pressure decreased more than 20 per cent from the baseline in more than half. The infants' Apgar scores at 1 and 5 minutes were 8.3 +/- 1.9; 8.2 +/- 1.6; 6.7 +/- 2.8, and 9.7 +/- 0.9; 9.8 +/- 0.7; 9.2 +/- 1.6 in EA, SA and GA group respectively. The adaptive capacity, active tone, passive tone, general assessment and primary reflexes of the NACS were not statistically different. CONCLUSION: Apgar scores of the infants whose mothers received general anesthesia were lower than infants whose mothers received regional anesthesia but the NACS were not statistically different among the three study groups.

Comparison of immediate recovery period among young, middle-aged and elderly patients.

We reported the immediate recovery period of 705 consecutive patients post general or head-neck-breast surgery, 590 were looked after in the recovery room (RR) and 115 were admitted into the intensive care unit (ICU) right after surgery. Group I were "young" (aged 15-45 years), group II were "middle aged" (46-60 years) and group III were "elderly" (> 60 years). Twenty-seven per cent of the elderly patients were sent to the ICU, whereas, 8.4 per cent of the young and 14.7 of the middle-aged group were looked after in the ICU. In RR patients, the young group were in better ASA class and had significantly fewer underlying diseases than the middle-aged and elderly groups; the most common of which were hypertension, diabetes and anemia. Elderly patients spent a significantly longer time in the RR than the young group but the risk of complication was not different. The most frequent complication was pain and elderly patients more frequently suffered from pain than the young group. Post-anesthetic recovery score (after Aldrete and Kroulik) was lower in the elderly on arrival and at 15, 30, 60 minutes in the RR but there was no clinical significance. In ICU patients, the 3 groups' intubation rates were not different and although the duration of intermittent positive pressure ventilation and duration of stay in the ICU were longest in the elderly group, there was no statistically significant difference. The mortality rate was highest in the elderly. We concluded that elderly patients had a worse immediate recovery period.