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ANALYSIS OF OUTCOME OF GENARAL VERSUS SPINAL ANAESTHESIA FOR

ANALYSIS OF OUTCOME OF GENARAL VERSUS SPINAL ANAESTHESIA FOR CAESAREAN DELIVERY IN SEVERE PRE-ECLAMPSIA WITH FOETAL COMPROMISE Speaker

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ANALYSIS OF OUTCOME OF GENARAL VERSUS SPINAL ANAESTHESIA FOR

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  1. ANALYSIS OF OUTCOME OF GENARAL VERSUS SPINAL ANAESTHESIA FOR CAESAREAN DELIVERY IN SEVERE PRE-ECLAMPSIA WITH FOETAL COMPROMISE Speaker Dr. Md. Harun-or- RashidM.B.B.S, M.C.P.S, D.A, F.C.P.S (Anesthesiology)ConsultantIntensive Care UnitMymensingh Medical College Hospital Chairperson Prof. Dr. Munirul Islam Prof & Head of the Deptt. Anesthesiology & Intensive Care Mymensingh Medical College & Hospital

  2. Source: Biomedica/ New Journal, vol.20 (July – Dec, 2004) Place of study: Pakistan Naval Hospital Shifa Karachi, Pakistan. STUDIED BYMUHAMMAD HASAN-UL-HAQ DEPARTMENT OF ANAESTHESIA, MILITARY HOSPITAL, RAWALPINDI, PAKISTAN

  3. INTRODUCTION: Pre-eclamptic toxaemia (PET) is a multi-systemic disorder that is characterized by endothelial cell dysfunction as a consequence of abnormal genetic and immunological mechanisms. Despite active research for years, the exact aetiology of this potentially fatal disorder remains unknown. Although understanding of the pathophysiology of pre-eclampsia has improved, management has not changed significantly over the years1.

  4. Cont: Anaesthetic management of these patients remains a challenge. Although general anesthesia can be used safely in pre-eclamptic women, it is fraught with greater maternal morbidity and mortality. Currently, the safety of regional anesthesia techniques is well established and they can provide better obstetrical outcome when chosen properly. Thus, regional anesthesia is extensively used for the obstetric management in women with pre-eclampsia1.

  5. Cont: Where caesarean section is required the relative risks of general anesthesia must be assessed. Regional anesthesia is usually considered safer, although cases must be assessed on an individual basis. The added risks associated with general anesthesia include airway difficulties due to oedema (often aggravated by tracheal intubations), and the presser response to laryngoscopy and extubation.

  6. Cont: During the last decade, after the advent of pencil point spinal needles and newer local anesthetic agents, it has been tried with favorable results. In most of the obstetrical centers it is now being used as anesthesia of first choice for pre-eclamptic patients6-9.

  7. Cont: The data from previous studies demonstrates that pre-eclampsia / eclampsia related complications and haemorrhage are the leading causes for admission of obstetric patients to the ICU10,11. Both are associated with increased risks of maternal morbidity and mortality12, which is more prevalent perioperatively in patients given general anesthesia as compared to regional anesthesia1.

  8. Cont: Most of these studies recommend further clinical trial to choose the best technique6-9. In their centre they have been using both the techniques of anesthesia, general as well as spinal since years and recently they have adopted this technique in 98% such patients.

  9. STUDY DESIGN Retrospective comparative analysis of peri-operative morbidity and mortality in severe pre-eclampsia, was conducted after approval of Hospital Research Council, at Pakistan Naval Hospital Shifa Karachi Pakistan, from Jan 2002 to Dec 2003.

  10. PATIENTS AND METHODS Sixty patients who had DBP> 110 mmHg and proteinuria > 3+, were selected for study. 30 patients were given general anaesthesia (GA group) & 30 were delivered under spinal anaesthesia (SA group). Incidence of morbidity, mortality & admission in ICU were noted.

  11. Cont: Foetal compromise criteria includes heart rate (HR) <60 (bradycardia) and >150 (tachycardia).

  12. Cont: Exclusion criteria Patients with deranged coagulation profile, antipartum haemorrhage, intrauterine death or impending eclampsia, were excluded from study.

  13. Table 2: Demographic Data.

  14. Technique of spinal anaesthesia

  15. Role of Anaesthesiologist in pre-eclamptic patient. • To assist with pain management in labour • To provide anaesthesia for Caesarean Section • To assist in the Intensive Care Management of life threatening complications which may arise from this condition. • Special attention 01. Control of blood pressure. 02. Optimization of intra vascular volume. 03. Optimization of renal function. 04. Prevention of convulsion. 05. Maintenance of oxygenation.

  16. Comparison Of the advantages & disadvantages of general vs. Spinal anaesthesia in pre-eclampsia

  17. Cont:

  18. Statistical analysis Data was analyzed by using SPSS version 10. Student,s t- test was used for mean comparison of significant factors and Variance test (ANOVA) for inter and intra group analysis of the parameters.

  19. Results Statistically incidence of hypotension and bradycardia was significantly (p<0.05) high in SA group but hypertension and tachycardia was more (p<0.05) in GA group. But clinically haemodynamic changes in both the groups, were in acceptable and manageable limits during the procedure.

  20. Table 3: Incidence of morbidity & mortality in GA and SP groups.

  21. Table 4 : Indications for admission in ICU

  22. DISCUSSION There are several reasons for preferring spinal anaesthesia to general anaesthesia for caesarean sections. Babies born to mothers having spinal anaesthesia may be more alert and less sedated as they have not received any general anaesthetic agents through the placental circulation.

  23. Contd- One previous study (Ahmed SM, et al) showed that the incidence of complications following GA (68.8%) were significantly (P<0.05) more than that of SA (47.1%)16.

  24. Contd- Dyer and Farbas in their prospective, randomized trial comparing general with spinal anaesthesia for caesarean delivery in preeclamptic patients concluded that one-minute APGAR scores were significantly lower (p<0.05) after general anaesthesia than spinal anaesthesia but 5 minutes scores were almost similar8.

  25. Contd- The data from a previous study conducted at United Arab Emirates University, demonstrate that hypertensive related complications (25%) and haemorrhage (28.5%) are the leading causes for admission of obstetric patients to the ICU18.

  26. Contd- A previous study conducted in India stated that the nature of complications following GA were more serious which may even lead to mortality (4.3%), whereas following spinal anaesthesia it was less serious and easily manageable. Hence GA is not as safe as it is thought16.

  27. CONCLUSION Spinal anaesthesia should be used as first choice for severe pre-eclamptic patients, which is as safe as general anaesthesia, with less post-operative morbidity and mortality.

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