General versus Neuraxial Anesthesia in Cesarean Section: A Systematic Review

Abstract

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.

Elective Cesarean Section under General Anesthesia Experience in more than 5,000 Patients at Melinda Women Hospital Bandung-Indonesia

“…To have successful airway management, complete preparation of the tools to free the airway must be ensured, such as the provision of the direct laryngoscope, stylet mandarin, bougie, and video laryngoscope. In addition, prediction of the difficult airway should be made through the implementation of complete airway preoperative examinations such as the Mallampati test, thyromental distance, open mouth, neck circle, and body mass index (BMI) to prevent complications during the procedure [2], [15], [16], [17], [18].…”