Retrospective evaluation of anesthetic techniques in cesarean section

The most important intervention in obstetric surgery is cesarean section with an increasing incidence of approximately 25% of all deliveries. While trying to maintain the safety and optimal conditions of only one person in anormal surgical anesthesia, Cesarean section anesthesia must secure the lives of the mother and the fetus that is dependent on any change of the mother' s well-being. Our study was done at Ege University Faculty of Medicine, Department of Obstetrics and Gynecology after the approval of our hospital ethics committee. In this study, anesthesia management and neonatal records of the patients who underwent cesarean section operation between January 2015 and December 2015 in Ege University Faculty of Medicine Department of Obstetrics and Gynecology were retrospectively screened. The demographic data of the patients (age, weight, height), number and week of pregnancy, parity, emergency or elective cesarean section, comorbid diseases, duration of operation, newborn Apgar score, height and weight of newborn, applied anesthesia technique( general, spinal, epidural and combined spinal epidural), newborns' 1. and 5. minute APGAR scores and maternal intensive care unit need were recorded. The effects of these methods on mother and newborn were evaluated. SPSS 21.0 for Windows program was used for statistical analysis. Descriptive statistics were presented as numbers and percentages for categorical variables, mean, standard deviation and median for numerical variables. ANOVA test when the normal distribution assumption is provided for multiple independent group comparisons for numerical variables, Kruskal Wallis Test if not provided; T test was used when the normal distribution assumption was provided in binary independent group comparisons. For the categorical variables, Chi-square test statistic was used for multiple and double group comparisons when Chi-square condition was provided. Pearson statistic was used for correlations where normal distribution was related to numerical data. The level of statistical significance was accepted as the value of p less than 0.05 When the age, height and weight of the patients included in the study were evaluated, the mean age of the patients was 30,08 ± 5,54 (min: 20, max: 45), the mean height was 161,69 ± 6,25 cm ) and the weight average was found as 78,08 ± 13,31 kg (min: 42, max: 163). The highest number of pregnancies was 2 in 31.8% of the pregnancies, while the highest number of parity was 0 in 40% and 1 in 37.2%. When the anesthesia methods applied to our study were examined, 83.7% of the patients were given spinal anesthesia, 11.6% were given general anesthesia, 2.9% were given epidural-spinal combined anesthesia and 1.8% were given epidural anesthesia. 58.1% of the cesarean section operations were performed electively whereas 41.9% were performed as an emergency. In addition, 0.36% of patients required additional anesthesia. 71.45% of the patients had given birth in the 36-40th week of their pregnancies. When additional diseases due to pregnancy were examined 68% of the patients had no pregnancy related diseases, 9.4% had preeclampsia, 4% had placenta previa totalis, 1% ablated placenta, 1.1% pregnancy cholestasis, and GDM in 6.4%. When the additional diseases found in the patients were examined, 57.6% had no additional disease, 1.2% had DM, 1.4% had HT, 11.3% had thyroid disorder, 5.3% had hematologic disorders , Cardiac diseases and asthma in 2.6%, liver disease in 2.5% and other diseases in 12.5%. Among a total of 1657 first born infants , 76 were admitted to the intensive care ward and 32 of these were dead; among the 92 second born infants 15 were admitted to intensive care unit and 4 were dead. The mean birth weight of the first infants was 3020 ± 802.4 g (min: 600, max: 5500), the mean birth weight of the second infants was 2117 ± 603.2 g (min: 890, max: 4070) The third born infants'mean weight was found to be 1673,33 ± 552,25 g (min: 1564, max: 1830). When the heights of these babies are examined; the average height of the first born infants was 34 ± 4,3 cm (min: 32, max: 60), the average height of the second born infants was 44,97 ± 3,01 cm (min: 38, max: 51) The mean height of the third born infants was 40 ± 1 cm (min: 39, max: 41). When the patients' intensive care needs were assessed in the postoperative period,2 patients were admitted to the internal medicine intensive care unit, 4 patients were admitted to the anesthesiology and reanimation intensive care unit and 1 patient was admitted to the pulmonology intensive care unit. Which anesthesia method should be applied in obstetric anesthesia should be decided considering the urgency of the operation, the pathologies existing in the patient, the advantages and disadvantages of each method, the preference of the patient and the experience of the anesthetist. In stable emergency situations that require an early section although not presenting a life threatining condition, regional anesthesia and most preferably spinal anesthesia is applied. In matters of very unstable emergencies that endanger the well-being of the mother or the fetus usually general anesthesia is used. We believe that regional anesthesia is a safe choice method for both mother and newborn. Based on the results of this retrospective research we have done, we believe that we should consider many factors together when choosing anesthesia method in pregnancy. It was concluded that general anesthesia should be administered only if indicated. When applying regional anesthesia methods, factors such as the urgency of the operation and the comorbidities due to pregnancy and independent of pregnancy should be taken into consideration.