Muloshi, Carol Musonda (2013) Neonatal Apgar Score Outcomes in Spinal Versus General Anaesthesia at the University Teaching Hospital (U.T.H), Lusaka. Masters thesis, University of Zambia.
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Abstract
Caesarean delivery cases have been steadily increasing in recent times. The national caesarean section rate in Zambia is not documented but the rate at the University Teaching Hospital was 20.6% in 2007 (Mukeshimana, 2007) and it is now 25%. Choice of regional or general anaesthesia for caesarean delivery depends among others on the expertise of the anaesthesiologist, the past medical history of the patient, choice of the patient, indication and urgency of the caesarean section (Beilin, 2004). Regional anaesthesia is safer for the mother and has been highly advocated for because of difficulties in airway management in pregnant women leading to difficult intubation and thus increasing maternal mortality (Bloom et al, 2005). There are no audits done previously documenting the caesarean sections done either under general anaesthesia or spinal anaesthesia at UTH, however, the researcher was able to compile figures based on cases done. An audit of UTH obstetric records by this researcher revealed that a total of about 2692 caesarean sections were done between January and December 2014. Of these, 620 were under general anaesthesia while 2072 were under spinal anaesthesia. On average, two (2) elective caesarean sections are done per day with approximately 40 per month. Of these most are done under spinal anaesthesia in a ratio of about 8 spinal anaesthetics cases to 1 general anaesthetic case. General anaesthesia can be carried out using different anaesthetic drugs. Most of the drugs affect the baby in two ways: by direct effect from placental drug transfer and by indirect effect resulting from maternal physiological and biochemical changes, which appear to be much more important. They may produce systemic effects in the baby like sedation, resulting in low Apgar score. Present anaesthetic techniques limit the dose of intravenous agents such that fetal depression is usually not clinically significant. Drugs used for spinal anaesthesia cause a sympathetic blockage thus resulting in vasodilatation and hypotension which can reduce maternal foetal circulation and may compromise the baby and cause low Apgar scores but this hypotension if treated well may reduce effects on the neonate (Solangi, 2012). In 1952, Dr Apgar an obstetric anaesthesiologist proposed the Apgar score as a means of rapid evaluation of the physical condition of infants shortly after the birth. When properly applied, it’s a tool for standardized assessment. It also provides a mechanism to record foetal-to-neonatal transition. The scores are taken at 1 and 5 minutes after delivery. Of the two scores, the 5 minutes score is regarded as the better predictor of survival in infancy in the long term. However, the 1 minute score definitely has the value for assessing the effects of different drugs given to the mother during the Caesarean section. This method is even more appealing because it is non-invasive (Solangi, 2012). The outcome of both the mother and the neonate should be taken into consideration when choosing regional or general anaesthesia for a caesarean delivery. Case fatality rate for Caesarean delivery was found to be higher in case of general anaesthesia as compared to regional anaesthesia (Dresner, 2004). Most hospitals in developed countries are now using more modern inhalational anaesthetic agents with fewer or no cardio-depressant effects e.g. Isoflurane or Sevoflurane. However at UTH, halothane is still widely used for maintenance of general anaesthesia and in much higher percentages despite well documented cardio depressant effects with minimal research as regards its effects on neonatal Apgar scores (Solangi, 2012).
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine > R Medicine (General) R Medicine > RD Surgery |
| Divisions: | Africana |
| Depositing User: | Geoffrey Obatsa |
| Date Deposited: | 03 Dec 2018 11:08 |
| Last Modified: | 03 Dec 2018 11:08 |
| URI: | http://thesisbank.jhia.ac.ke/id/eprint/7094 |
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