Evaluation of the maternal and neonatal effects of OUR general and regional anesthesia practices in cesarean section operations

Objective: In our study, it was aimed to determine the results of our routine anesthesia applications in cesarean section on mothers and newborns and the factors affecting these results, to compare our routine applications with scientific data, and to reveal and eliminate our deficiencies, if any. Materials and Methods: A total of 483 pregnant women who had an emergency/elective cesarean delivery at Akdeniz University Medical Faculty Hospital between June 2019 and June 2021 were included in the study. Demographic data, additional systemic diseases, applied anesthesia techniques and developing complications of all pregnant women were recorded. Cesarean section indication, drug treatments, if any, and urgency category of all cases were recorded. Routine hemodynamic monitoring was applied to all cases and HR and SAP, DAP, MAP measurements at the 5th, 10th, 15th, 20th and 30th minutes were recorded. In addition, the time between skin incision and delivery, the time between uterine incision and delivery, intraoperative hypotension, bradycardia, nausea-vomiting were recorded. Umbilical cord blood gases, 1st and 5th minute APGAR scores were recorded. The need for intensive care and mortality of the newborn and mother were followed up. Perioperative bleeding and surgical interventions in its management, blood and blood product replacement were recorded. Results: There was no significant difference between general and regional anesthesia groups in terms of demographic data (p>0.05). In pregnant women included in the study; the rate of preeclampsia/eclampsia was 14.5%, the rate of placental anomalies was 9.7%, the rate of birth with meconium due to fetal reasons was 1.2% and the fetal distress rate was 9.7%, the rate of repeated cesarean section was 52.2%. While 71.80% of the cases were term pregnancies, 28.20% were preterm pregnancies. While 54.3% of the pregnant women with preeclampsia were moderately severe, 45.7% had severe preeclampsia. Convulsions in 4.3%, cerebral hemorrhage in 1.4%, renal failure in 5.7%, elevated liver enzymes in 15.7%, DIC in 1.4%, HELLP syndrome in 8.6% of these pregnant women had. The regional anesthesia rate (62.7%) of the cases was higher than the general anesthesia rate (37.3%), and spinal anesthesia was applied to 57.5% of the pregnant women. 37.1% of cesarean sections were performed urgently and 62.9% were performed electively. The rate of regional anesthesia was higher in both emergency and elective cesarean sections. While the rate of regional anesthesia was higher in term pregnants than in preterm pregnants, the rate of general anesthesia was found to be higher in cases of placental anomalies, meconium delivery and fetal distress compared to regional anesthesia. In the general anesthesia group; while the increase at the 5th minute and the decrease at the 20th 30th minute and at the end of the operation were significant compared to the basal HR values (p<0.05); in the regional anesthesia group, the decreases in baseline HR values at the 20th 30th minute and at the end of the operation were significant (p<0.05). In the general anesthesia group; While the increase in the 5th minute values and the decreases in the 10th, 15th, 20th, 30th minute and post-operative values were significant compared to the basal SAB, DAB, MAP values (p<0.05); In the regional anesthesia group, the decrease in basal SAB, DAB, MAP values at the 5th, 10th, 15th, 20th, 30th minutes and at the end of the operation were significant (p<0.05). While there was no significant difference between the groups in terms of the time between uterine incision and delivery of the baby (p>0.05), the time between skin incision and delivery of the baby was significantly longer in the regional anesthesia group (p<0.05). Nausea-vomiting was observed in 19.8% of pregnant women who underwent regional anesthesia, vasopressor/inotrope requirement in 23.4%, and atropine requirement in 3.6%. Newborn 1st and 5th minute APGAR scores and umbilical cord pH values were found to be significantly higher in the regional anesthesia group (p=0.017). The umbilical cord pO2 value of the general anesthesia group was significantly higher (p<0.001). While 33.7% of newborns needed intensive care, intrauterine growth retardation was observed in 9.1% and fetal mortality was observed in 0.4%. While 7.2% of the pregnants needed intensive care, cerebral hemorrhage developed on the basis of eclampsia in one case and ARDS developed on the basis of DIC after postpartum hemorrhage in another case with thalassemia major, maternal mortality developed in a total of 2 cases. RBC replacement was applied to 14 pregnants out of 16 (%3,3) pregnants who developed intraoperative bleeding, FFP replacement was applied to 12 pregnants, and tranexamic acid was applied to 4 pregnants. In order to stop the bleeding, hypogastric artery ligation was performed in 2 pregnant women and total hysterectomy was performed in 9 pregnant women. Conclusions: General and regional anesthesia techniques have different maternal and neonatal advantages and disadvantages in cesarean section operations. However, since there are multiple factors affecting maternal and neonatal morbidity and mortality, anesthesiologists should be highly aware of all these factors, necessary preliminary preparations should be fully planned, should be in team spirit with the surgical team, and anesthesia and surgery should be performed in the safest way by evaluating the patient on a case-by-case basis.