The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study

2013 ◽  
Vol 41 (5) ◽  
pp. 573-579
Author(s):  
Gamze Sinem Caglar ◽  
Perihan Erdogdu ◽  
Aslı Yarcı Gursoy ◽  
Rabia Şeker ◽  
Selda Demirtas
Keyword(s):  
Cesarean Section ◽  
Cord Blood ◽  
General Anesthesia ◽  
Elective Cesarean Section ◽  
Blood Samples ◽  
Ischemia Modified Albumin ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Fetal Cord Blood ◽  
The Impact

Abstract Objective: Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. Methods: Seventy two women with uncomplicated term pregnancies were randomized to spinal (n=37) or general anesthesia (n=35) groups. The blood pressure, oxygen saturation, and pulse rate of the patients were recorded during the procedure. Maternal blood samples of ischemia modified albumin (IMA) were taken 10 min from the start of the procedure. The fetal cord blood samples of IMA were taken immediately after birth. Results: Maternal (0.99±0.19 vs. 0.80±0.27) and fetal (1.00±0.21 vs. 0.70±0.26) IMA levels were significantly higher in the general anesthesia group. Fetal IMA levels were positively correlated with maternal gravidity (r=0.31; P=0.008), parity (r=0.25; P=0.028), and fetal birth weight (r=0.23, P=0.045). Also, as time from incision to delivery lengthens, fetal IMA levels increase (r=0.29, P=0.012). Conclusion: Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested.

scholarly journals Effects of General Anesthesia Versus Spinal Anesthesia on Serum Cytokine Release after Cesarean Section: A Randomized Clinical Trial

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Maryam Vosoughian ◽  
Mastaneh Dahi ◽  
Shideh Dabir ◽  
Mohammadreza Moshari ◽  
Soodeh Tabashi ◽  
...  
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Serum Levels ◽  
Major Surgery ◽  
Necrosis Factor Alpha ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Tnf Α ◽  
Significant Difference

Background: Tissue damage caused by major surgery, such as cesarean section, may lead to a poor host immune response and excessive release of cytokines. These responses may increase the risk of infection, cause postoperative pain, and exert damaging effects on various body organs. Objectives: Anesthesia methods may affect cytokine production after surgery. This study aimed to compare the serum levels of cytokines in general and spinal anesthesia among women undergoing cesarean section. Methods: Thirty parturients (ASA class I and II) undergoing cesarean section were randomly assigned into two equal groups of spinal anesthesia and general anesthesia. Blood samples were taken for measuring the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) before induction of anesthesia and 30 minutes after entering the recovery room. Results: In the general anesthesia group, the postoperative serum levels of IL-6 and TNF-α were significantly higher than the corresponding preoperative levels. Significant differences were found between the two groups in the preoperative and postoperative levels of TNF-α. Changes in the IL-6 and TNF-α concentrations were significantly higher in the general anesthesia group as compared to the spinal anesthesia group. However, there was no significant difference in the IL-6:IL-10 and TNF-α: IL-10 ratios between the two groups. Conclusions: General anesthesia, as compared to spinal anesthesia, significantly increased the IL-6 and TNF-α levels after cesarean section. Therefore, the spinal anesthesia technique may be a better option for patients undergoing cesarean section.

scholarly journals Cord Blood Ischemia-Modified Albumin Levels in Normal and Intrauterine Growth Restricted Pregnancies

2008 ◽  
Vol 2008 ◽  
pp. 1-5 ◽  
Author(s):  
Nicoletta Iacovidou ◽  
Despina D. Briana ◽  
Maria Boutsikou ◽  
Sophia Liosi ◽  
Stavroula Baka ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cord Blood ◽  
Intrauterine Growth Restriction ◽  
Elective Cesarean Section ◽  
Ischemia Modified Albumin ◽  
Intrauterine Growth ◽  
Elective Cesarean ◽  
Appropriate For Gestational Age ◽  
Sparing Effect ◽  
Umbilical Cords

Ischemia-modified albumin (IMA) is a sensitive biomarker of cardiac ischemia. Intrauterine growth restriction (IUGR) may imply fetal hypoxia, resulting in blood flow centralization in favour of vital organs (brain, heart, adrenals—‘‘brain sparing effect’’). Based on the latter, we hypothesized that cord blood IMA levels should not differ between IUGR and appropriate-for-gestational-age (AGA) full-term pregnancies. IMA was measured in blood samples from doubly-clamped umbilical cords of 110 AGA and 57 asymmetric IUGR pregnancies. No significant differences in IMA levels were documented between AGA and IUGR groups. IMA levels were elevated in cases of elective cesarean section (P= .035), and offspring of multigravidas (P= .021). In conclusion, ‘‘brain sparing effect’’ is possibly responsible for the lack of differences in cord blood IMA levels at term, between IUGR and AGA groups. Furthermore, higher oxidative stress could account for the elevated IMA levels in cases of elective cesarean section, and offspring of multigravidas.

scholarly journals NEONATAL OUTCOME

2006 ◽  
Vol 13 (01) ◽  
pp. 72-78
Author(s):  
SOHAIL ABBAS SUKHERA ◽  
SALEEM AHMED
Keyword(s):  
General Anesthesia ◽  
Apgar Score ◽  
Neonatal Outcome ◽  
Elective Cesarean Section ◽  
Anesthetic Technique ◽  
Epidural Group ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Minute Interval ◽  
Minute Apgar Score

The choice of anesthetic technique for cesarean sections, a commonproblem faced by anesthetists remains controversial. Objective: To compare the effects of epidural anesthesia withgeneral anesthesia. To evaluate which mode is better especially keeping in mind the Apgar score of the newborn. Whichwas taken as the index of immediate neonatal outcome. Design: A prospective cohort study. Setting: CombinedMilitary Hospital Peshawar. Period: Six months. Material & Methods: A total of hundred patients aged between 26-35years were selected who were under going elective cesarean section. Results: The gestational ages of the newbornwere between 36 and 40 wks. The patients were divided into two groups of fifty each receiving the two modes ofanesthesia. A random sampling of the patients was done. Apgar scores of the newborn babies were taken at 01 and05 minute intervals. Computer based SPSS 8.0 was used to analyze the results and it was found that none of the babieswas severely depressed, (Apgar score less than 4 at 01-minute interval in both the groups). 2% of the cases weremoderately depressed, (Apgar score 4-6 at 01-minute interval in the epidural group as compared to 10% of the casesborn under general anesthesia). In the epidural group 4% of the cases had 01 minute Apgar score of less than 8compared to 36% in the general anesthesia group. As regards the 05 minute Apgar score 6% of the patients had Apgarscore less than 10 in the epidural group compared to 11% in the general anesthesia group. This showed that epiduralanesthesia has an advantage over general anesthesia especially as regards 01 minute Apgar score as well as beingsafe for the mother. So this mode of anesthesia should be preferred.

scholarly journals Evaluation Of Anxiety During Nasal Pack Removal In Patients Operated Under Local Versus General Anesthesia

2018 ◽  
Vol 08 (04) ◽  
pp. 226-230
Author(s):  
Amer Sabih Hydri ◽  
Muhammad Junaid Alam ◽  
Iqbal Hussain Udaipurwala ◽  
Furqan Mirza
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Rating Scale ◽  
Military Hospital ◽  
General Anesthesia Group ◽  
Nasal Pack ◽  
Assessment Scores ◽  
Anesthesia Group ◽  
Group B ◽  
Hamilton Anxiety

Objective: To evaluate the anxiety experienced before, during and after conventional paraffin gauze nasal pack removal in patients operated under local versus general anesthesia. Study design: Comparative study. Place and duration of study: Department of ENT, Combined Military Hospital Sialkot and PAF Hospital Shorkot from July 2017 to June 2018. Material and methods: A total of 120 patients planned for Septoplasty were enrolled and divided into two groups. Sixty patients were to be operated under local anesthesia (Group A) while the other 60 were undergoing the same procedure under general anesthesia (Group B). Conventional paraffin gauze nasal packing was done for 24 hours in all 120 patients. Hamilton Anxiety Rating Scale (HAM-A) was used to determine the patients’ anxiety in both groups, 1 hour pre-operatively, immediately before and 1 hour after nasal pack removal. Results: The mean Hamilton Anxiety Scale assessment scores in both groups were of ‘mild’ category. The highest scores in both groups were observed immediately before nasal pack removal, with a range of 15-18, while the lowest scores in both groups were documented one hour after pack removal with a range of 13-16. Anxiety level in patients operated under general anesthesia was slightly lower than patients administered local anesthesia mean score of 16.40 ± 0.763 vs 17.21 ± 0.666 (p<0.001). Conclusion: Anxiety during nasal pack removal is mainly associated with prior pain experienced during nasal pack insertion. It is recommended that proper analgesia, adequate topical anesthesia, gentle insertion would make this process less distressing and will subsequently result in less anxiety at its removal.

scholarly journals The Effect of Sevoflurane Anesthesia for Dental Procedure on Neurodevelopment in Children: A Prospective, Equivalence, Controlled Trial

2020 ◽  
Author(s):  
Pinping Zhou ◽  
Chao Zhang ◽  
Guijin Huang ◽  
Yuan Hu ◽  
Wenzhu Ma ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Age Groups ◽  
Outcome Data ◽  
Clinical Trial Registry ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Significant Difference

Abstract Background: Dental procedures under general anesthesia (DGA) was found to improve the oral health-related quality of children's life. However, some parents and pediatricians expressed concern about the neurotoxicity of general anesthesia. The purpose of this trial was to investigate whether DGA in children has an adverse effect on neurodevelopment.Methods: In this prospective, assessor-masked, controlled, equivalence trial, we recruited 340 children younger than 7 years who were undergoing caries treatment between Feb 1, 2019, and Aug 31, 2019, without factors affecting neurodevelopment. They received either sevoflurane-based general anesthesia or awake-local anesthesia. The Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition was used to evaluate the neurodevelopment of children at six months after surgery, and the Full-Scale IQ (FSIQ) was selected as the primary outcome. Predefine the 95% CI of a difference in means within five (1/3 SD) as the equivalence margin.Results: The outcome data were obtained from 129 children in the general anesthesia group and 144 in the local anesthesia group. The median length of general anesthesia was 130 min (IQR 110 – 160). There was equivalence in means of FSIQ score between the general anesthesia group and the local anesthesia group (local minus general anesthesia 0.46, 95% CI -2.35 to 1.61). There was no significant difference in FSIQ scores between different age groups and different anesthesia durations. Only the mother's education could affect the primary outcome.Conclusions: In this trial, prolonged DGA with a sevoflurane-only anesthetic in preschool children, does not adversely affect neurodevelopment at six months after surgery compared with awake-local anesthesia. Trial registration: Chinese Clinical Trial Registry, ChiCTR1800015216. Registered Mar 15 2018, http://www.chictr.org.cn/showproj.aspx?proj=24830.

scholarly journals Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0249808
Author(s):  
Jorge Kiyoshi Mitsunaga ◽  
Vinicius Fernando Calsavara ◽  
Elton Shinji Onari ◽  
Vinicius Monteiro Arantes ◽  
Carolina Paiva Akamine ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Laparoscopic Surgery ◽  
General Anesthesia ◽  
Controlled Trial ◽  
Spinal Block ◽  
Trendelenburg Position ◽  
General Anesthesia Group ◽  
Randomized Controlled ◽  
Anesthesia Group ◽  
Oncologic Patients

Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2–9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.

Could spinal anesthesia be a choice for retrograde intrarenal surgery

2018 ◽  
Vol 85 (4) ◽  
pp. 169-173 ◽  
Author(s):  
Ibrahim Karabulut ◽  
Erdem Koc ◽  
Ali Haydar Yilmaz ◽  
Elif Oral Ahiskali ◽  
Ercument Keskin ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Analogue Scale ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
General Anesthesia Group ◽  
Group I ◽  
Anesthesia Group ◽  
Spinal Anesthesia Group

Objective: In this study, we aimed to compare cases of retrograde intrarenal surgery performed under spinal or general anesthesia through investigating relevant parameters for the first time in the literature. Material and method: In total, 86 patients with diagnosis of kidney stone who were treated by retrograde intrarenal surgery were included in this randomized controlled prospective study. In total, 43 of these operations were performed under spinal anesthesia (group I) and 43 were performed under general anesthesia (group II). The groups were compared in terms of demographic features, American Society of Anesthesiologists score, duration of operation, complication rates, postoperative visual analogue scale, postoperative hospitalization period, stone-free rates, and cost value ratios. Results: There were no significant differences between the two groups in terms of demographic findings, preoperative stone loads, postoperative stone-free rates, complication rates and postoperative hospitalization periods (p > 0.05). Postoperative visual analogue scale scores and cost value ratios were found statistically significantly lower in the spinal anesthesia group (group I) when compared with the general anesthesia group (group II; p < 0.001). Conclusion: Performing retrograde intrarenal surgery in the presence of spinal anesthesia is equally effective with general anesthesia. Spinal anesthesia also appears to be a more advantageous method due to statistically significantly lower mean postoperative pain scores and treatment cost value ratios.

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