Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Saygı, Anıl İçel; Özdamar, Özkan; Gün, İsmet; Emirkadı, Hakan; Müngen, Ercüment; Akpak, Yaşam Kemal

doi:10.1590/1516-3180.2014.8901012

Cited by 52 publications

(51 citation statements)

References 35 publications

(27 reference statements)

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“…[1][2][3] Shivering is a common and distressing side effect which is associated with increased oxygen consumption, carbon dioxide production, and metabolic rate. Shivering may also interfere with intraoperative monitoring of electrocardiogram, blood pressure (BP), and pulse oxygen saturation.…”

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confidence: 99%

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Liu

et al. 2017

Biological & Pharmaceutical Bulletin

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Shivering associated with spinal anesthesia during Cesarean delivery is an uncomfortable experience for the parturient, which may also cause adverse effects. In this prospective, randomized, double-blind, placebocontrolled study, we sought to evaluate the effect of intrathecal dexmedetomidine, administered as an adjunct to hyperbaric bupivacaine for Cesarean delivery, on the incidence and severity of shivering associated with spinal anesthesia. Patients undergoing Cesarean delivery were randomly allocated to three groups of 30 patients each. Experimental treatments were added to hyperbaric bupivacaine as follows: Patients in group I (control) were administered isotonic saline. Patients in groups II and III received dexmedetomidine (2.5, 5 µg, respectively), mixed with isotonic saline. Shivering was observed in 11, 10 and 2 patients in groups I, II and III, respectively. The incidence of shivering in group III was significantly lower than that in groups I (p 0.005) and II (p 0.01). The severity of shivering was significantly different between the three groups (p 0.01). There were no significant inter-group differences with respect to mean arterial pressure and heart rate at any time point after administration of intrathecal local anesthesia (p>0.05). Intrathecal dexmedetomidine (5 µg) administered as an adjunct to hyperbaric bupivacaine during Cesarean delivery significantly reduced the incidence and intensity of shivering associated with spinal anesthesia.

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mentioning

confidence: 99%

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Liu

et al. 2017

Biological & Pharmaceutical Bulletin

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“…Only 3 studies were judged as low risk of bias (10,15,18). Selection bias and attrition bias were the main problems in methodology.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

“…We judged this item as low risk of bias in 7 studies, five of which used computer-generated random number table (5-7, 10, 13) and two of which generated sequence by drawing lots (15,18). We judged this item as unclear risk of bias in the rest eight included studies, because they did not describe detailed randomized method (8,9,11,12,14,16,17,19).…”

Section: Sequence Generation (Selection Bias)mentioning

confidence: 99%

“…We judged this item as low risk of bias in 4 studies, two of which concealed allocation in sealed envelopes (7,10) and two of which by drawing lots (15,18). We judged this item as high risk of Ru-Rong Wang et al …”

Section: Allocation Concealment (Selection Bias)mentioning

confidence: 99%

“…Five studies (10,13,15,17,18) reported risk of Apgar score <7 at 1 minute after delivery. It indicated that newborns had higher risk of lower than 7 Apgar score at 1 minute after delivery in maternal general anesthesia group (RR 4.81, 95% CI 1.72 to 13.46) (Figure 4).…”

Section: Risk Of Neonatal Apgar Score <7 At 1 and 5 Minutes After Delmentioning

confidence: 99%

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General versus Neuraxial Anesthesia in Cesarean Section: A Systematic Review

Yang¹,

Xu²,

Yang³

et al. 2017

J Anesth Perioper Med

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Background: Neuraxial anesthesia is preferred anesthesia technique for cesarean section. But recently the safety of general anesthesia improved well. So it is important to clarify the safety of general anesthesia and neuraxial anesthesia for cesarean section. Methods: We searched CENTRAL/Ovid (September, 2016), EMBASE/Ovid (1974 to October 12, 2016, MEDLINE/Ovid (1946 to October 12, 2016. We only included randomized controlled trials (RCTs) which compared general anesthesia versus neuraxial anesthesia including spinal anesthesia, epidural anesthesia or combined spinal and epidural anesthesia in cesarean section. Two authors independently assessed the studies for inclusion, extracted the data and performed the analysis. Results: A total of 1394 mothers were involved in the 15 included studies. For neonatal outcomes, at 1 minute after delivery, Apgar score was significantly lower in maternal general anesthesia group (mean difference[MD] -0.71, 95% confidence intervals [CI] -0.99 to -0.43) and the risk of newborns for Apgar score lower than 7 was higher when the mother underwent general anesthesia (risk ratio [RR] 4.81, 95% CI 1.72 to 13.46). At 5 minutes after delivery, Apgar score was still lower in maternal general anesthesia group (MD -0.31, 95% CI -0.59 to -0.02), but the risk of newborns for Apgar score lower than 7 showed no difference in statistical analysis under general or neuraxial anesthesia (RR 2.31, 95% CI 0.08 to 64.48). Besides, no neonatal deaths were reported, and risk of oxygen by mask or intubation (RR 1.23, 95% CI 0.33 to 4.53) also showed no difference in statistical analysis in both groups. For maternal outcomes, there were more blood loss in general anesthesia group (MD 75.8, 95% CI 21.18 to 130.41), but the risk of receiving postoperative blood transfusion was similar in both groups (RR 2.85, 95% CI 0.93 to 8.72). Besides, the risk of shivering (RR 8.00, 95% CI 1.14 to 56.33), nausea (RR 1.47, 95% CI 0.99 to 2.17) and vomiting (RR 4.13, 95% CI 1.41 to 12.09) was higher in general anesthesia group. But the risk of headache (RR 0.11, 95% CI 0.01 to 0.87) and pruritus (RR 0.13, 95% CI 0.02 to 0.99) was higher in neuraxial anesthesia group. Conclusions: For clinical practice, we recommended neuraxial anesthesia as first choice in cesarean section. For further clinical researches, more non-surrogate outcomes should be reported, such as maternal and neonatal mortality and morbidity.

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Predictors of immediate neonatal outcome after cesarean section in Uganda

Båvenäs

Möller

Bhandarkar

et al. 2021

Intl J Gynecology & Obste

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Child health is a priority in global health and United Nations Sustainable Development Goal 3 states that preventable deaths of newborns and children under five must end by 2030. In addition, all countries should reduce the neonatal mortality rate to at most 12 per 1000 live births by 2030. 1 The past few decades have seen a substantial decline of the mortality rate in under-5s, but with little progress for the youngest children. The risk of dying during childhood is highest in the first month of life, with an average of 18 deaths per 1000 live births. In 2017, this translated into 2.5 million deaths of children less than 1 month old. Three-quarters of these children die during the first week after birth and a third die the same day they are born. 2 Stillbirth rates have declined more slowly than the maternal mortality ratio and the under-5 mortality rate. In 2009, there were an estimated 2.6 million stillbirths, of which 98% occurred in low-or middle-income countries. 3 Half of the 7200 stillbirths that occur every day are often preventable intrapartum stillbirths. 3,4 Cesarean sections are, when medically justified,

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Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

Cited by 52 publications

References 35 publications

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

Intrathecal Dexmedetomidine Alleviates Shivering during Cesarean Delivery under Spinal Anesthesia

General versus Neuraxial Anesthesia in Cesarean Section: A Systematic Review

Predictors of immediate neonatal outcome after cesarean section in Uganda

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