الفهرس 
Maternal Physiological ConsiderationOnly 14 pages are availabe for public view
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Abstract
Internationally, obstetric anesthesia guidelines recommend spinal and epidural over GA for most caesarean sections. The primary reason for recommending regional blocks is the risk of failed endotracheal intubation and aspiration of gastric contents in pregnant women who undergo GA, while there is evidence that GA is associated with an increased need for neonatal resuscitation.
The question posed regarding the effect of general versus regional anesthesia on NRA Scores and acid–base balance is an interesting one. This subject has been studied by many investigators over the years, as regarding Apgar score, most commonly retrospectively and in the setting of elective cases. Some have shown no difference in Apgar scores and ABGs between the groups. Some have reported NA is better. In this study, we used a new score to assess fetal outcome.
The study was done on 240 consecutive women with uncomplicated single pregnancies at term and scheduled to undergo elective CS participated in this prospective observational study. They divided into 2 groups of equal size (each 120), a GA group (G) and Spinal anesthesia group (R).
The study measured the following: umbilical artery blood gas analysis, NRA Scores were assessed at 1 and 5 min from delivery (primary outcome of the study), maternal BP, SpO2 and HR were measured preoperative and every 3 minutes until delivery of baby and maternal satisfaction regarding type of anesthesia.
The study revealed that 1st minute NRA Score of spinal anesthesia was better than with general anesthesia (P= <0.001), but regarding 5th minute NRA Score there was no difference between the two groups (P= 0.105). This can be attributed to the general anesthesia short-term effect on newborns and has no long term effect on the neonates. Also, there was a lower systolic and diastolic blood pressures in patients received spinal anesthesia and reflex tachycardia than in patients received GA, it could be due to the sympathetic block associated with regional anesthesia, it was rapidly and successfully treated by fluid bolus and ephedrine shots. Patient satisfaction was significantly higher in spinal anesthesia group when compared to general anesthesia group.
So, Spinal anesthesia demonstrates better neonatal outcome with favorable safety profile than general anesthesia. Further evaluations in future by large studies on emergency cesarean sections are recommended.