Neonatal Apgar Score Outcomes in Spinal Versus General Anaesthesia at the University Teaching Hospital (UTH), Lusaka.
Keywords:
Apgar score, Halothane, General anaesthesia and Spinal anaesthesia
Abstract
Background: The knowledge gap was from the fact that the type of anaesthetic drug administered during caesarean section can have effects on neonatal outcome like low Apgar score with most hospitals in developed countries now using more modern inhalational anaesthetic agents with fewer or no cardio-respiratory depressant effects e.g. Isoflurane or Sevoflurane. However at UTH, halothane is still being used for maintenance of general anaesthesia despite well documented cardio-respiratory depressant effects with very limited research done on its effects on neonatal Apgar score. The Apgar score is a means of rapid evaluation of the physical condition of infants shortly after birth. Thus this study investigated the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. Objective and study design: With the view of determining the type of anaesthesia administered during caesarean section with the least effects on neonatal wellbeing shortly after birth, a prospective observational cohort study was conducted at the University Teaching Hospital between May 2015 and January 2016.The scientific objective was to determine the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. This study involved 70 neonates, 54 were born from mothers that had undergone caesarean section under spinal anaesthesia and 16 from mothers that had undergone general anaesthesia. The data was analysed using SPSS version 16.0. Inferential analysis was conducted using logistic regression. Results: 20 neonates out of 54 (37%) in the spinal anaesthetic group had an Apgar score less than 8 at 1 minute[Fig 1]. Out of the 16 neonates in the general anaesthesia group, 14 (87.5%) had Apgar score less than 8 at 1 minute[Fig 1]. One (1.9%) neonate had an Apgar score less than 8 at 5 minutes in the spinal anaesthesia group. While 4 (25%) neonates had Apgar score less than 8 in the GA group[Fig2] The logistic regression at 1 minute Showed that it is over 11 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 11.9), [Table 3]. The Apgar score at 1 minute in the Spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.002). The logistic regression at 5 minutes Showed that it is over 17 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 17.7), [Table 4]. Further, the 5 minutes Apgar score in the spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.014),[Table 4]. Conclusion: With the results pointing to the fact that there is significant difference in neonatal Apgar score outcomes in spinal versus general anaesthesia, the researcher therefore rejected the null hypothesis. It is therefore inferred that spinal anaesthesia method has better neonatal outcomes by Apgar score measure than general anaesthesia method.References
1. Mukeshimana JM. Post caesarean section complications at the University Teaching Hospital, Lusaka. 2007.
2. Beilin Y. Anaesthesia for caesarean delivery: regional or general? In: Fleisher LA, editor. Evidence based practice of anaesthesiology. Philadelphia: Saunders, 2004. P.401-5.
3. Bloom, SL, Spong, CY.et al (2005).Complications of anaesthesia for caesarean delivery: ObstetGynecol, Volume 106, 2005, pp.281-287.
4. Solangi SA, Siddiqui SM, Khaskheli MS, Siddiqui MA. Comparison of the effects of general versus spinal anaesthesia on neonatal outcome. Anaesthesia Pain & Intensive Care 2012; 16(1):18-23.
5. Dresner M. Anaesthesia for elective caesarean section. In: Pollard BJ, editor. Handbook of clinical anaesthesia. 2nd ed. Edinburgh: Churchill Livingston, 2004. p.466-9.5
6. Zagorzycki MT, Brinkman, CR. (1982). The effect of general and epidural anaesthesia upon neonatal Apgar scores in repeated caesarean section; SurgGynecol Obstet. 1982 Nov; 155(5):641-5.
7. Aftab I, Sultan M, Masroorudin, Noor H, H.A,Khalid I.(2009).Effect of Spinal and General Anaesthesia Over APGAR Score in Neonates Born After Elective Caesarean Section.JLUMHS 9(3):151-154.
8. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am CollCardiol. 1998 Nov. 32(5):1486-588.
9. Apgar V, James L. (1962). Further observation of the newborn scoring system. American Journal of Diseases of Children. 1962; 104:419–428.
10. Baraka A, Louis F, Dalleh, R. (1990). Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for Caesarean section.Canadian Journal of Anaesthesia, 37(6), 641-644.
11. Cyna AM, Dodd J. Clinical update: obstetric anaesthesia. Lancet 2007; 370:640-42.
12. Gundumure G, (2002).Characteristics and determinants of caesarean section and cord prolapsed at the University Teaching Hospital, Lusaka.
13. Idowu OA, Mafiana CF, Sotiloye D. Anaemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. Afr Health Sci. 2005; 5:295–9.
14. Kavak ZN, Basgul A, Cehyan N. Short term outcome of new-born infants: Spinal versus general anaesthesia for elective caesarean section: a prospective randomized study. Eur J ObstetGynecol Rep Biol 2001; 100:50-4.
15. Ong BY, Cohen MM, Palahniuk RJ. (1989).Anaesthesia for caesarean section-effects on neonates.AnesthAnalg 1989; 68:270-5.
16. Rashid I, Behzad S, Khalid A, Tassaduq K, Imran UH, Ahmed A.Effect of general anaesthesia versus spinal anaesthesia on Apgar score in elective caesarean section, Karachi, 2012.
17. Reynolds F, and Seed P T. (2005).Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia, 60: 636–653. doi:10.1111/j.1365-2044.2005.04223.x.
18. Rogers J F, Graves W L. (1993). Risk factors associated with low Apgar scores in a low-income population; Paediatric and perinatal epidemiology 7 (2): 205-16.
19. Tumukunde J, Lomangisi, DD, Davidson O, Kintu A, Joseph E, &Kwizera A. (2015). Effects of propofol versus thiopental on Apgar scores in newborns and peri-operative outcomes of women undergoing emergency caesarean section: arandomized clinical trial. BMC Anesthesiology, 15, 63. http://doi.org/10.1186/s12871-015-0044-6
20. Sahana KS, Comparison of Apgar score in neonates: spinal versus general anaesthesia for elective caesarean sections: journal of evolution of medical and dental sciences 2014: vol 3, issue 03, January 20: Page 538-543.
21. Pedersen JE, Fernandes A, Christensen M.Halothane 2% for caesarean section. Eur J Anaesthesiol.1992 Jul: 9(4):319-24.
22. Cullinane M, Gray AJG, Hargreaves, Lucas S,Max S,Herry K.M et al. (2004).Scoping our practise, The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death, NCEPOD.London.
2. Beilin Y. Anaesthesia for caesarean delivery: regional or general? In: Fleisher LA, editor. Evidence based practice of anaesthesiology. Philadelphia: Saunders, 2004. P.401-5.
3. Bloom, SL, Spong, CY.et al (2005).Complications of anaesthesia for caesarean delivery: ObstetGynecol, Volume 106, 2005, pp.281-287.
4. Solangi SA, Siddiqui SM, Khaskheli MS, Siddiqui MA. Comparison of the effects of general versus spinal anaesthesia on neonatal outcome. Anaesthesia Pain & Intensive Care 2012; 16(1):18-23.
5. Dresner M. Anaesthesia for elective caesarean section. In: Pollard BJ, editor. Handbook of clinical anaesthesia. 2nd ed. Edinburgh: Churchill Livingston, 2004. p.466-9.5
6. Zagorzycki MT, Brinkman, CR. (1982). The effect of general and epidural anaesthesia upon neonatal Apgar scores in repeated caesarean section; SurgGynecol Obstet. 1982 Nov; 155(5):641-5.
7. Aftab I, Sultan M, Masroorudin, Noor H, H.A,Khalid I.(2009).Effect of Spinal and General Anaesthesia Over APGAR Score in Neonates Born After Elective Caesarean Section.JLUMHS 9(3):151-154.
8. ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am CollCardiol. 1998 Nov. 32(5):1486-588.
9. Apgar V, James L. (1962). Further observation of the newborn scoring system. American Journal of Diseases of Children. 1962; 104:419–428.
10. Baraka A, Louis F, Dalleh, R. (1990). Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for Caesarean section.Canadian Journal of Anaesthesia, 37(6), 641-644.
11. Cyna AM, Dodd J. Clinical update: obstetric anaesthesia. Lancet 2007; 370:640-42.
12. Gundumure G, (2002).Characteristics and determinants of caesarean section and cord prolapsed at the University Teaching Hospital, Lusaka.
13. Idowu OA, Mafiana CF, Sotiloye D. Anaemia in pregnancy: A survey of pregnant women in Abeokuta, Nigeria. Afr Health Sci. 2005; 5:295–9.
14. Kavak ZN, Basgul A, Cehyan N. Short term outcome of new-born infants: Spinal versus general anaesthesia for elective caesarean section: a prospective randomized study. Eur J ObstetGynecol Rep Biol 2001; 100:50-4.
15. Ong BY, Cohen MM, Palahniuk RJ. (1989).Anaesthesia for caesarean section-effects on neonates.AnesthAnalg 1989; 68:270-5.
16. Rashid I, Behzad S, Khalid A, Tassaduq K, Imran UH, Ahmed A.Effect of general anaesthesia versus spinal anaesthesia on Apgar score in elective caesarean section, Karachi, 2012.
17. Reynolds F, and Seed P T. (2005).Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia, 60: 636–653. doi:10.1111/j.1365-2044.2005.04223.x.
18. Rogers J F, Graves W L. (1993). Risk factors associated with low Apgar scores in a low-income population; Paediatric and perinatal epidemiology 7 (2): 205-16.
19. Tumukunde J, Lomangisi, DD, Davidson O, Kintu A, Joseph E, &Kwizera A. (2015). Effects of propofol versus thiopental on Apgar scores in newborns and peri-operative outcomes of women undergoing emergency caesarean section: arandomized clinical trial. BMC Anesthesiology, 15, 63. http://doi.org/10.1186/s12871-015-0044-6
20. Sahana KS, Comparison of Apgar score in neonates: spinal versus general anaesthesia for elective caesarean sections: journal of evolution of medical and dental sciences 2014: vol 3, issue 03, January 20: Page 538-543.
21. Pedersen JE, Fernandes A, Christensen M.Halothane 2% for caesarean section. Eur J Anaesthesiol.1992 Jul: 9(4):319-24.
22. Cullinane M, Gray AJG, Hargreaves, Lucas S,Max S,Herry K.M et al. (2004).Scoping our practise, The 2004 Report of the National Confidential Enquiry into Patient Outcome and Death, NCEPOD.London.
Published
2021-01-28
How to Cite
1.
Muloshi C. Neonatal Apgar Score Outcomes in Spinal Versus General Anaesthesia at the University Teaching Hospital (UTH), Lusaka. Journal of Agricultural and Biomedical Sciences [Internet]. 28Jan.2021 [cited 22Dec.2024];4(4). Available from: https://library.unza.zm/index.php/JABS/article/view/339
Section
Biomedical Sciences
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