A Clinical Study of Anesthesia for Cesarean Section / 대한마취과학회지

ABSTRACT

Anesthesia for cesarean section involves consideration of Loth maternal and fetal welfare. The choice of anesthesia for cesarean section is controversial. Regional analgesic techniques may be least harmful to the fetus, but suffer definite drawbacks; they are time-consuming, and therefore not always applicable when urgent surgery is indicated; are associated with a definite failure rate even in skilled hands, and require considerable technical ability and practice. Recently there has been progressive increase in the use of balanced anesthesia for cesarean section, it produces little or no hemodynamic and acid-base disturbance in the mother and infant if administered skillfully. The value of muscle relaxants to facilitate endotracheal intubation and pulmonary ventilation and to permit the use of light general anesthesia. From November, 1971 to October, 1973 there were 1,432 deliveries, of which 1,284 were delivered vaginally and 148 (10.3%) by cesarean section. Of the cesarean section group, 139 were performed under general anesthesia and 9 were performed under regional anesthesia. The characteristic difference for our series was that most of all cases were emergency cesarean section (71.6%). The major indication for surgery was that of a previous cesarean section (45.3%), the second most common cause was dystocia (42.9%), and the others are as following order; Hemorrhage (5.4%), toxemia (3.4%), and others (3.4%). In our study, we adopted two different general anesthetic techniques for cesarean section. Patients were randomly assigned to two groups Group I 112 patients, thiopental-succinylcholine-nitrous oxide-oxygen (6733) anesthesia. Group II 25 patients, thiopental-succinylcholine-nitrous oxide-oxygen (5050) supplemented with 0.5~1.0% of halothane anesthesia. All patients were pre-oxygenated for 3 5 minutes and anesthesia was then induced with thiopental sodium 125~250mg, followed by succinylcholine 40~50 mg to facilitate intubation. Pressure was maintained on the cricoid cartilage to prevent regurgitation following loss of consciousness. After the affects of succinylcholine showed signs of wearing off, relaxation was maintained with 0.1% succinylcholine drip or 40~80 mg of gallamine. Anesthesia was maintained with nitrous oxide 4 l/min. and oxygen 2 l/min. and/or nitrous oxide 2 l/min. and oxygen 2 l/min. supplemented with 0.5~1.0% of halothane. Respiration was carefully controlled by manually so as not to producing hyperventilation. The clinical condition of newbron infant in general anesthesia series of 135 cases, mean minute apgar score were good (7~10) in 91.8 percent, fair (4~6) in 6.7 per cent, and poor (1~3) in 1.5 per cent. And 90.4 per cent of babies born within 10 minutes of induction to delivery time interval (IDI) had mean apgar score of 8. 8, 5.8 per cent were delivered after 11 to 15 minutes of IDI with decreased mean apgar score of 7.6, and 3.7 per cent were delivered after over 15 minutes of IDI had mean apgar score of 7. 6. A short IDI appears to be advantageous from the standpoint of the newborn. Of the 144 infants, 6. 9 per cent of newbron infants(10) received intermittent positive pressure breathing by face mask and 3.5 per cent(5) received oxygen through an endotracheal tube for the resuscitation. Neonatal death occurred only 1(0.69%) case out of 144 infants, which caused by severe fetal. distres associated with toxemia of pregnancy. There were no maternal death or anesthetic complication.. At the conclusion, the technique of general anesthesia with thiopental-succinylcholine-nitrous oxide-oxygen and/or supplemented with 0.5~1.0% of halothane was proved to be safe for mother and child, and showing a wide acceptance of general anesthesia for cesarean section(94%) at the Kyung Hee University Hospital.