Department of Obstetrics and Gynaecology

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Browsing Department of Obstetrics and Gynaecology by Subject "Anaesthesia"

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    Open Access
    Regional versus general anaesthesia for caesarean section
    (Cochrane Database Syst Rev, 2006) Afolabi, B.B.; Lesi, A.F.E; Merah, N.A
    Background: Regional and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious. Objectives: To compare the effects of regional anaesthesia (RA) with those of GA on the outcomes of CS. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to December 2005), and EMBASE (1980 to December 2005). Selection criteria: Randomised and quasi-randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication. Data collection and analysis: Two authors independently assessed trials for inclusion, data extraction and trial quality. Main results: Sixteen studies (1586 women) were included in this review. Women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit (weighted mean difference (WMD) 1.70, 95% confidence interval (CI) 0.47 to 2.93, one trial, 231 women) and (WMD 3.10, 95% CI 1.73 to 4.47, one trial, 209 women). Compared to GA, women having either an epidural anaesthesia or spinal had a lower estimated maternal blood loss (WMD -126.98 millilitres, 95% CI -225.06 to -28.90, two trials, 256 women) and (WMD -84.79 millilitres, 95% CI -126.96 to -42.63, two trials, 279 women). More women preferred to have GA for subsequent procedures when compared with epidural (odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, one trial, 223 women) or spinal (OR 0.44, 95% CI 0.24 to 0.81, 221 women). The incidence of nausea was also less for this group of women compared with epidural (OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women) or spinal (OR 23.22, 95% CI 8.69 to 62.03, 209 women). No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at one and five minutes and need for neonatal resuscitation with oxygen. Authors' conclusions: There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.
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    Open Access
    Spinal and general anaesthesia for emergency caesarean section: effects on neonatal Apgar score and maternal haematocrit
    (Niger Postgrad Med J, 2003) Afolabi, B.B.; Kaka, A.A.
    This is a prospective comparative study to determine the effect of the type of anaesthesia used for emergency Caesarean section on neonatal and maternal outcome. The patients were recruited into the study after being given either general or spinal anaesthesia. Neonatal outcome was assessed using Apgar scores and need for respiratory assistance at birth. Maternal outcome was assessed using the difference between pre- and post-operative packed cell volumes (PCV), need for blood transfusion and estimated blood loss. The groups were matched for pre-existing risk factors. Apgar scores at 1 and 5 minutes were found to be significantly lower for the general anaesthesia group (GA) than the spinal anaesthesia group (SA) and need for respiratory assistance was greater for the GA group. Difference between pre- and post-operative PCV and need for blood transfusion were also significantly greater in the GA group. This study confirms that the current practice of spinal anaesthesia for Caesarean section in the Lagos University Teaching Hospital is a good one, but further studies need to be done to assess other outcome variables.
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    Open Access
    Urgency of surgery and presence of maternal disease influence the choice of anaesthesia for Caesarean section at LUTH.
    (Niger Postgrad Med J, 2007-06) Desalu, I.; Afolabi, B.B.
    Aims and objectives: Worldwide, Caesarean sections are commonly done under regional anaesthesia which offers numerous advantages over general anesthesia. However there are still indications for the use of general anaesthesia in obstetric practice. This includes emergent Caesarean sections. This study sought to determine the factors that inform the decision on the choice of anaesthesia for Caesarean section in a tertiary institution in Nigeria. Patients and methods: All patients scheduled for elective and emergency caesarean sections between January and December 2002 were prospectively studied. Study variables included age of mother, gestational age and parity. Urgency of surgery, indication for surgery, maternal pre-existing disease and the choice of anaesthetic technique were documented. Neonatal weight was recorded and outcome was assessed by Apgar score at 1 and 5 minutes, the presence of respiratory difficulties and the need for admission into the Neonatal unit. Results: One hundred and ninety-six patients were studied. Elective surgery was performed for 17.3%, while 47.4% and 28.6% had urgent and emergency Caesarean sections respectively. Urgency of surgery was not documented in 6.7% of cases. Previous caesarean section was the commonest indication for elective procedures (47%), foetal distress for emergency (62.5%) and previous caesarean section in labour for urgent procedures (30.1%). General anaesthesia was employed in 33.2% of patients while regional anaesthesia was used in 66.8%. Fifty per cent of emergency cases had general anaesthesia. Regional anaesthesia was used in 72% of urgent and 85.3% of elective procedures. The commonest regional technique was spinal anaesthesia (60.7%). Nineteen per cent of our patients had a co-existing medical problem, and 73% of these received a spinal anaesthetic. More neonates delivered under general anaesthesia had respiratory difficulties at birth (p=0.002) and more were admitted to the Neonatal unit (p=0.031). Conclusion: The choice of anaesthesia depends on the urgency of surgery and the medical condition of the mother. General anaesthesia was more likely to be administered for bleeding emergencies and foetal distress. Spinal anaesthesia was preferred for elective and urgent cases or when maternal disease existed.