Clinical Evaluation of Anesthesia for Cesarean Section / 대한마취과학회지

ABSTRACT

To provide optimal obstetric anesthetic care, it is essential for the anesthetist to know well the maternal physiological alterations produced by pregnancy, labor and paturition, physiology and pharmacology of the fetal placental complex and how these are altered by analgesics and anesthetics (Bonica, 1972). Recently, the tendency to cesarean section has increased; the cesarean section rate was 8.1. (Lee et al., 1974) and 15% (Dripps et al., 1977). Choice of regional or general anesthesia for cesarean section depends on many factors. As, the paturient is considered to have a full stomach, regional anesthesia is advantageous. However, if the indication is fetal distress or maternal hemorrhage, the necessity for rapid delivery overrides all other considerations. For elective cesarean section the choice of anesthesia largely relates to patients condition and physicans preference, although the somewhat. longer time required for delivery in a repeated cesarean section may indicates regional rather than general anesthesia (Dripps et al., 1977; James et al., 1977). The problem of anesthetic management of cesarean section was fetal depression due to sedatives, analgesics and anesthetics during delivery. In emergency cesarean section, the major problem in general anesthesia is aspiration of gastric contents and in regional anesthesia it is hypotension. Regarding fetal and neonatal depression associated with anesthesia, the effects of general or regional anesthesia or. the neonatal neurobehavioral status have been reported by many authors (Standley et al., 1974; Tronick et al., 1976; Hollmen et al., 1978). Thus we have made a clinical analysis of anesthesia for 300 cases by random sampling among 1725 cesarean sections. including emergency and elective operations, performed from July 1973 to June 1978 in Severance Hospital at Yonsei University College of Medicine. Clinical analysis was made of frequency of cesarean section, age distribution, parity, indication of cesarean section, physical status (A.S.A. classification), premedication, anesthetic method, relationship between Apgar score and the type of anesthesia, relationship between induction to delivery time and one minute Apgar score, time to initial blood pressure drop after spinal anesthesia, blood loss, the methods of cardiopulmonary resuscitation of the newborn, perinatal mortality and neonatal neurobehavioral states. The result are as follows 1) The incidence of cesarean action was 18.4 percent of total deliveries and the tendency is increasing. 2) One minute Apgar score in spinal anesthesia is better than in general anesthesia (0. 01 < p < 0.025). 3) Blood loss in spinal anesthesia (566+/-146 ml) is less than in general anesthesia(796+/-388ml). 4) Blood pressure showed a drop within ten minutes in 83 percent of cases after induction of spinal anesthesia. 5) Perinatal mortality of general anesthesia (3.9%) is more than spinal anesthesia (1.9%). Even though clinical results of spinal anesthesia seem to be more favorable than those of general anesthesia, from the above observation it may be concluded that choice of anesthesia for cesarean section depends on each maternal condition and only one anesthetic method should not be exclusively used.