Analysis of outcome of general versus spinal anaesthesia for caesarean delivery in severe pre-eclampsia with foetal compromise

ABSTRACT

The aim of this study was to evaluate and compare the outcome of general versus spinal anaesthesia for caesarean delivery in mothers with pre eclampsia and foetal compromise. Retrospective comparative analysis of peri-operative morbidity and mortality in severe pre eclampsia, conducted at Pakistan Naval Hospital Shifa Karachi, Pakistan, from Jan 2002 to Dec 2003. Sixty patients who had diastolic blood pressure >110 mmHg and proteinuria >3+, were selected for study. Thirty patients were given general anaesthesia [GA group] and 30 were delivered under spinal anaesthesia [SA group]. Incidence of morbidity, mortality and admission in intensive care unit, were noticed. Statistically, incidence of hypotension and bradycardia was significantly [p<0.05] high in SA group but hypertension and tachycardia were more [P<0.05] in GA group. Clinically haemodynamic changes in both the groups, were in acceptable and manageable limits during the procedure. One-minute Apgar scores were lower in GA group [6 us. 8] but there was no difference in 5 min scores. Postoperative complications were significantly [p<0.05] more common in GA group [66.7% vs. 16.6%] as compared to SA group. Admission ratio in ICU and total hospital stay, GA vs. SA group was 41 and 21 respectively. Mortality was more in GA group [6.6% vs. 0%] as compared to SA group. As a conclusion, we advocate that spinal anaesthesia should be used as first choice for severe pre eclamptic patients, which is safer than general anaesthesia, with less postoperative morbidity and mortality