Women undergoing caesarean section under regional anaesthesia should routinely receive supplementary oxygen

Jordan, Michael J.

doi:10.1054/ijoa.2002.0990

Cited by 16 publications

(9 citation statements)

References 13 publications

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“…In 19 of the studies in this analysis, maternal oxygen supplementation was given, while the remainder did not mention it. Now even that shibboleth has become the subject of controversy [70]. It can be postulated that maternal hyperoxia could cause hypoventilation and consequent CO 2 retention in mother and fetus and placental vasoconstriction.…”

Section: Maternal Inhaled Oxygen Concentrationmentioning

confidence: 99%

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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SummarySpinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid-base status provides a valid index of fetal welfare. Twenty-seven studies reporting neonatal acid-base data with different types of anaesthesia were used to compare umbilical artery or vein pH and base deficit, using random-effect meta-analysis. Cord pH was significantly lower with spinal than with both general (difference: )0.015; 95% CI )0.029 to )0.001; 13 studies, 1272 subjects) and epidural anaesthesia (difference )0.013; 95% CI )0.024 to )0.002; 11 studies, 828 subjects). Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434-1.784 mEq.l )1 ; seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222-1.598 mEq.l ; seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus. In labour, regional analgesia has a more favourable effect on the newborn than systemic analgesia [1][2][3], a fact that tends to be neglected by consumers and carers alike. By contrast, it is widely accepted that regional anaesthesia for Caesarean section is preferable to general anaesthesia. Spinal anaesthesia is commonly considered both more practical and safer than other techniques for the mother, and is therefore widely used [4]. It is often assumed, similarly, that spinal anaesthesia for Caesarean section must be better for the baby than general or epidural anaesthesia. There are several reasons for this assumption.• General anaesthesia was shown in the 1970s to depress the Apgar score, although this is reversible and rarely significant by 5 min [5,6].• Maternal hypotension, which is believed to be detrimental to fetal wellbeing, can be minimised by appropriate vasopressor control. Cardiac output, however, is more likely to be impaired by spinal than by epidural anaesthesia [7], is rarely measured and may not be so easily corrected.• The doses of drugs required to induce spinal anaesthesia are small and are therefore unlikely to produce systemic effects in the baby. With the brief duration of anaesthesia before delivery of the baby, however, pharmacological fetal depression is likely to be less important than that following prolonged maternal administration of depressant drugs, as may occur during labour. It must be borne in mind, moreover, that drugs may affect the baby in two ways: firstly via a direct effect, resulting from placental drug transfer, which is transient even when general anaesthesia is used for Caesarean section, and clearly unimportant with spinal anaesthesia; and secondly, through an indirect effect resulting from maternal physiological or biochemical changes, which Anaesthesia, 2005, 60 , pages 636-653 .........................................................................................................................................

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Section: Maternal Inhaled Oxygen Concentrationmentioning

confidence: 99%

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

2005

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“…Routine administration of supplemental oxygen to women undergoing Caesarean section under regional anaesthesia is practiced in many centres. This is aimed at improving foetal oxygenation and acid-base status, as well as increasing maternal oxygen reserve to enhance her ability to cope with stress of anaesthesia and surgery (8,9). However, some publications (1,6,10,11) have raised doubts about the benefit of this practise.…”

Section: Discussionmentioning

confidence: 99%

Supplemental oxygen for Caesarean section under spinal anaesthesia

Adenekan

Faponle²,

Azebi³

2011

E Af Med Jrnl

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Results:The mean pre-induction arterial oxygen saturation in the two groups were similar. There was a statistically significant difference in the mean SaO 2 at one minute between the two groups, with the control group being higher (97.7% ± 1.5% versus. 96.7% ± 1.5%; p-value = 0.008). The mean least SaO 2 during surgery was also higher in the control group (95.9% ± 1.5% versus 94.9% ± 2.0%, p-value = 0.015). The Apgar score of the babies at one and five minutes for the study and control group were similar. Conclusion: Healthy parturients undergoing Caesarean section under spinal anaesthesia do well without supplemental oxygen; administration of supplemental oxygen from the common gas outlet of anaesthetic machine with the breathing circuit and standard anaesthetic facemask at 4L/min causes relative desaturation.

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“…125 This practice has been justified by the belief that raising the oxygen reserve of the mother is universally beneficial for the fetus. Since the advent of pulse oximetry, patients who may benefit from oxygen therapy are more easily identified, and clinicians can be more selective about administering oxygen therapeutically.…”

Section: Fetal Effects Of Maternal Oxygen Administrationmentioning

confidence: 99%

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

Littleford

2004

Can J Anesth/J Can Anesth

115

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P Pu ur rp po os se e: : To review the effects of maternal anesthesia and analgesia on the fetus and newborn.M Me et th ho od ds s: : An on-line computerized search of Medline, Embase, and the Cochrane Collaboration via PubMed was conducted. English language articles were selected. The bibliographies of relevant articles and additional material from other published sources were retrieved and reviewed.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : No one test clearly separates the effects on the fetus/newborn, if any, of maternally administered medication during labour and delivery, or during surgery for non-obstetric indications. Supposition in this regard is limited in part by methodology previously used to study the transplacental passage of various drugs. This work needs to be repeated using a human model. Routine maternal supplemental oxygen administration is being questioned in light of research showing that free radical generation and oxidative stress are implicated as the underlying mechanisms in several neonatal conditions. Maternal hypotension is associated with neonatal acidemia and base excess correlates with neonatal outcome. Common postpartum analgesics transfer minimally into breast milk. Maternal or fetal surgery conducted during pregnancy necessitates modification of both anesthetic and surgical approaches. The key to resuscitation of the fetus is resuscitation of the mother: intra-uterine maneuvers, including perimortem Cesarean section, aim to reverse treatable causes of fetal asphyxia, restore fetal oxygenation, and correct fetal acidosis.C Co on nc cl lu us si io on ns s: : The well-being of the infant is a major criterion for evaluating the anesthetic management of pregnant women. Many tools exist to assist with this determination for the fetus, whereas few are available to evaluate the newborn. Méthode : Une recherche informatisée en ligne des bases Medline et Embase et du Centre de collaboration Cochrane via PubMed a été réalisée. Des articles de langue anglaise ont été sélectionnés. Les bibliographies d'articles pertinents et du matériel additionnel d'autres publications ont été retenus et passés en revue. Constatations principales : Aucun test ne sépare clairement les effets sur le foetus/nouveau-né, si effet il y a, des médicaments administrés à la mère pendant le travail et l'accouchement ou pendant une intervention chirurgicale non obstétricale. Les hypothèses possibles

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Women undergoing caesarean section under regional anaesthesia should routinely receive supplementary oxygen

Cited by 16 publications

References 13 publications

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Anaesthesia for Caesarean section and neonatal acid‐base status: a meta‐analysis*

Supplemental oxygen for Caesarean section under spinal anaesthesia

Effects on the fetus and newborn of maternal analgesia and anesthesia: a review

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