Evaluation of the effects of spinal and general anesthesia applications on neonatal cerebral oxygenation in cesarean section operations

Objective: In our study, it was aimed to compare and evaluate the effects of spinal and general anesthesia methods applied in cesarean section operations on neonatal brain oxygenation by recording cerebral regional oxygen saturation and vital values in the first 16 minutes of the newborn's transition to extrauterine life. Materials and Methods: 49 pregnant women who had elective cesarean delivery at Akdeniz University Medical Faculty Hospital between January 2020 and January 2023 were included in the study. Demographic data of all pregnant women and anesthesia techniques applied were recorded. Routine hemodynamic monitoring was applied to all cases and HR, MAP and SpO2 measurements were recorded at the specified time intervals. In addition, the periods between the onset of anesthesia, skin incision, uterine incision and delivery of the baby, intraoperative hypotension, bradycardia, and whether the pregnant women used vasopressors when needed were recorded. Umbilical cord blood gases, newborn birth weights, 1st and 5th minute APGAR scores were recorded. HR, SpO2, crSO2 and cFTOE values of the newborns were recorded at the specified time intervals (for 16 minutes). Results: In the comparison of maternal HR between groups, the values in Group 2 at skin incision were found to be significantly higher than Group 1 (p<0.05). In the comparison of maternal MAP between groups; skin incision, newborn delivery and placental expulsion values were found to be significantly lower in Group 1 compared to Group 2 (p<0.05). No significant difference was found in terms of oxygenation parameters (SpO2, crSO2 and cFTOE) between newborns in groups (Group 1 and 2). HR values was found to be lower only in Group 1 at 2 minutes compared to Group 2 (p=0.045). When the values of newborns of mothers who need and do not need vasopressors are compared; HR was found to be significantly higher in infants of mothers who needed vasopressors compared to infants of mothers who did not need vasopressors (p<0.0045). Considering NIRS values; the newborns of mothers who needed vasopressors were significantly lower (p<0.0001) and the FTOE values were significantly higher (p<0.0001) compared to newborns of mothers who did not need vasopressors. There was no significant difference between the two groups for newborn SpO2 values (p>0.05). When the umbilical cord blood gas values were compared between the groups; values in Group 1 for lactate and pH were found to be significantly higher than those in Group 2 (p= 0.042 for pH, p=0.0014 for lactate). When pCO2 value was compared between the groups, the mean value in Group 2 was found to be higher than in Group 1 (p=0.008). There was no significant difference between the two groups for pO2, glucose and hemoglobin values (p>0.05). Conclusions: It has been shown that the effects of general and spinal anesthesia in elective cesarean sections on neonatal crSO2 and cFTOE during the transition to neonatal life have similar effects, crSO2 and cFTOE changes in both groups are in acceptable limits in line with the studies in the literature. Another result we obtained is; in the spinal anesthesia group, crSO2 values were found to be lower and cFTOE values to be higher in the newborns of the pregnant women who used vasopressors due to maternal hypotension. This suggests that vasopressor therapy applied to the mother may have a negative effect on neonatal crSO2 by affecting uteroplacental perfusion. Keywords: cesarean section, cerebral oxygenation, general anesthesia, spinal anesthesia