///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Anesthesia for cesarean section in premature infants

Abstract Number: 82
Abstract Type: Original Research

Robin Russell MD FRCA1 ; Yaroslav Stefak FRCA2; Toby Thomas FRCA3

Introduction: Spinal anesthesia (SA) for cesarean delivery has been associated with potentially harmful effects on the baby when compared to epidural and general anesthesia (GA).1,2 Most data come from studies of elective surgery in term infants; little is known of the effect on outcome in premature infants.

Methods: Notes of women who underwent cesarean delivery at <33 weeks gestation in 2006-07 were reviewed. Data on anesthetic technique and neonatal outcome were collected. The health of the baby at 28 days and 3 months was recorded.

Results: 118 cases were identified of which 78 case notes were available. There were 9 twin deliveries. SA was used in 58 cases, GA in 18 and epidural in 2. Epidurals were not included in further analysis. Maternal age, gestation and birth weight were similar. The median dose of bupivacaine for SA was 12.5mg (range 10-15mg). Fentanyl was added in 55 cases (median 15mcg, range 12.5-45mcg) and diamorphine in 7 (median 300mcg; range 200-300mcg). Phenylephrine was used in 18 cases; ephedrine in 6. Similar doses of bupivacaine were used with each vasoconstrictor. Apgar scores were similar in SA and GA groups (P>0.05). Umbilical venous gases were available in 49 and 15 cases and arterial gases in 51 and 13 cases of SA and GA, respectively. There were no significant differences between groups (P>0.05). There were no significant differences between SA and GA groups in the health of the baby at 28 days and 3 months. No difference in Apgar scores, cord gases or longer term outcome was observed between phenylephrine and

ephedrine.

Discussion: We did not find a significant difference in neonatal outcome between SA and GA for cesarean delivery in premature infants. However, numbers are small and data retrospective. Further studies are needed to determine the optimal mode of anesthesia for cesarean delivery in premature infants.

References

1. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia 2005; 60: 636-53.

2. Tonni G, Ferrari B, De Felice C, Ventura A. Fetal acid-base and neonatal status after general and neuraxial anesthesia for elective cesarean section. Int J Gynecol Obstet 2007; 97: 143-6.



SOAP 2009