Spinal versus general anesthesia in cesarean section

comparative study

1. Spinal versus General Anesthesia in Cesarean Section A comparative study   BY   Reema sareb Akram abo Agaga Marwa alkarbash Essra ayad     Supervised by Dr . Ryadh Edriss Belkhiria

2. **Acknowledgement ** We would like to express our gratitude for everyone who helped us during the graduation project . supervisor Dr.Ryadh Edriss Dr . Kawthar Aboukraa And the head of department Dr Fatma Lashkham The members of the jury To all our doctors ,friends and especially our families

3. Introduction Definition Cesarean section: Abdominal delivery/ major surgery (1). intervention for preventing maternal and neonatal mortality,and morbidity(8). associated with several complications (4). an increase in C-section rates of up to 60% (5,6,7)

4. HISTORY : 1885 Corning - First attempt with epidural cocaine 1901 use of cocaine as an epidural agent for humans and dogs Alternative to general anesthesia 1921 Pagis - First lumbar anesthesia for surgery 1947 Lidocaine commercially available 1979 Cousins - Epidural opioids provide analgesia

5. Indications of cesarean section MATERNAL INDICATIONS Pre- eclamsia D.M, Cardiac disease, contracted Pelvis . FETAL INDICATIONS Fetal distress , macrosomia , malpresentations (transverse, brow, Some breech) . MIXED INDICATIONS Feto -maternal disproportion, eclamptic fit Placenta previa , abruptio placeta and any cause of haemorrhagia Major causes in causes

6. Contraindication of cesarean section No absolute Contraindication( C/I) of cesarean section Relative C/I: fetal death or severe malformations with possible vaginal delivery situations in risk with general anesthesia

7. Choice of procedure: The anesthesiologist has the master decision in the choice between general anesthesia or spinal block, according to the choice of the patient .

8. Choice’ The anesthesiologist must choose the safest and most comfortable method for the mother, and the least depressant process for the newborn (72)

9. Aim of the study compare the advantages & disadvantages and complication of general versus spinal anesthesia in Cesarean section and try to find out the best procedure in relationship with the indication

10. Advantage Anesthetic methods used during cesarean section have advantages and disadvantages to both mothers and neonates, and may result in short- and long-term neonatal effects.

11. Advantage general 1. Speed of induction 2. Reliability 3. Reproducibility 4. Controllability 5. Avoidance of hypotension (75).

12. Advantage general RAPIDTY: Extreme emergencies: situations where there is necessity to end the pregnancy or deliver the baby immediately as during eclamptic fit, great heamorrhage or shocked patient………. Adequat analgesia Muscle relaxation less associated hypotension Situation when spinal puncture is contraindicated: spine malformation, infection hypotension……

13. Advantage spinal 1. Simplicity of technique 2. Speed of induction (in contrast to an epidural block) 3. Reliability 4. Minimal fetal exposure to the drug(s) 5. An awake parturient 6. Minimization of the hazards of aspiration (78).

14. Advantage spinal No potential problems as during GA may occur including pulmonary aspiration of gastric content, failed intubation, maternal hyperventilation, neonatal depression, maternal awareness and uterine atony

15. disadvantages of general anesthesia 1. maternal aspiration 2. Problems of airway management 3. Narcotization of the newborn 4. Maternal awareness during light general anesthesia (81).

16. Spinal anesthesia disadvantage 1. Accidental intravascular injection with a possibility of convulsion, cardiovascular collapse, and aspiration. 2. Accidental subarachnoid injection causing total spinal anesthesia with the possibility of severe hypotension, unconsciousness, and aspiration. Obviously, in both these situations, ventilation with 100% oxygen will be absolutely essential and airway may have to be secured (83).

17. GA COMPLICATIONS Failed intubation pulmonary aspiration and hypothetically increase the risk of regurgitation, increased fatty tissue , complete dentition , laryngeal oedema , drug dosage differences , large tongue , and large breasts postoperative nausea and vomiting

18. COPLICTIONS OF SPINAL Hypotension : 0% to more than 50% in non pregnant patients Bradycardia rare rare causes include excessive sedation, preexisting autonomic dysfunction, heart block, vaso-vagal reaction , (59,60,61) Nausea and Vomiting quite rare most often associated with hypotension Cardiac Arrest 2.5–6.4 per 10,000 anesthesia Backache 20% Urinary retention postoperative urinary retention ( POUR) 5-70%

19. Compare between general and spinal anesthesia complications:   Spinal anesthesia General anesthesia Hypotension Hypertension nausea and vomiting nausea and vomiting Backache Not effect Urinary retention Not effect Bradycardia Tachycardia Not effect Failed intubation

20. Spinal General Not effect Drugs toxicity Not effect pulmonary aspiration Not effect increased fatty tissue Not effect regurgitation Not effect haemorrhage Not effect laryngeal oedema

21. CONCLUSION one of the most commonly performed world-wide. Regional anesthesia has become the preferred technique for Cesarean delivery and Compared to general anesthesia, regional anesthesia is associated with reduced maternal mortality and morbdity .

22. CONCLUSION Spinal anaesthesia have the advantage for caesarean deliveries because it is speeds up the recovery process postoperatively and is more safe for both mother and fetus however General anaesthesia may be preferred in special cases, especially in urgent and emergency cases to decrease the initiation time of surgery

23. CONCLUSION , Both general and spinal anaesthesia are reliable and well tolerated for elective caesarean section. However, we noted that postoperative pain relief and decrease use of additional medication with non steroidal analgesic as diclofenac was superior with the spinal technique.,

24. CONCLUSION . We have the opinion that spinal anesthesia is superior to general anesthesia in terms of fetal wellbeing . Furthermore, with regard to pregnancies with fetal problems, we consider that it would be more appropriate to prefer the method of spinal anesthesia by taking first minute Apgar scores into account

25. CONCLUSION OF THE CONCLUSION spinal anesthesia the anesthetic method-of-choice for cesarean sections . Subarachnoid block (SAB) is considered simpler and safer than other techniques of anaesthesia for caesarean delivery and is, therefore, the technique of choice of most anaesthesiologists .

26. Recommendation for future study Recommend Research about modern technique and less complication in spinal anesthesia and recommend patient chose spinal technique .  

27. THANK YOU