J Anesth Perioper Med. 2017;4(3):114-122. https://doi.org/10.24015/ebcmed.japm.2017.0028
From 1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China; 2Department of Anesthesiology, Sichuan Provincial People's Hospital, Chengdu, China.
*Lei Yang and Xu Cheng contributed equally to this work.
Correspondence to Dr. Ru-Rong Wang at 576950028@qq.com.
EBCMED ID: ebcmed.japm.2017.0028 DOI: 10.24015/ebcmed.japm.2017.0028
Background
Neuraxial anesthesia is preferred anesthesia technique for cesarean section. But recently the safety of general anesthesia improved well. So it is important to clarify the safety of general anesthesia and neuraxial anesthesia for cesarean section.
Methods
We searched CENTRAL/Ovid (September, 2016), EMBASE/Ovid (1974 to October 12, 2016), MEDLINE/Ovid (1946 to October 12, 2016). We only included randomized controlled trials (RCTs) which compared general anesthesia versus neuraxial anesthesia including spinal anesthesia, epidural anesthesia or combined spinal and epidural anesthesia in cesarean section. Two authors independently assessed the studies for inclusion, extracted the data and performed the analysis.
Results
A total of 1394 mothers were involved in the 15 included studies. For neonatal outcomes, at 1 minute after delivery, Apgar score was significantly lower in maternal general anesthesia group (mean difference[MD] -0.71, 95% confidence intervals [CI] -0.99 to -0.43) and the risk of newborns for Apgar score lower than 7 was higher when the mother underwent general anesthesia (risk ratio [RR] 4.81, 95% CI 1.72 to 13.46). At 5 minutes after delivery, Apgar score was still lower in maternal general anesthesia group (MD -0.31, 95% CI -0.59 to -0.02), but the risk of newborns for Apgar score lower than 7 showed no difference in statistical analysis under general or neuraxial anesthesia (RR 2.31, 95% CI 0.08 to 64.48). Besides, no neonatal deaths were reported, and risk of oxygen by mask or intubation (RR 1.23, 95% CI 0.33 to 4.53) also showed no difference in statistical analysis in both groups. For maternal outcomes, there were more blood loss in general anesthesia group (MD 75.8, 95% CI 21.18 to 130.41), but the risk of receiving postoperative blood transfusion was similar in both groups (RR 2.85, 95% CI 0.93 to 8.72). Besides, the risk of shivering (RR 8.00, 95% CI 1.14 to 56.33), nausea (RR 1.47, 95% CI 0.99 to 2.17) and vomiting (RR 4.13, 95% CI 1.41 to 12.09) was higher in general anesthesia group. But the risk of headache (RR 0.11, 95% CI 0.01 to 0.87) and pruritus (RR 0.13, 95% CI 0.02 to 0.99) was higher in neuraxial anesthesia group.
Conclusions
For clinical practice, we recommended neuraxial anesthesia as first choice in cesarean section. For further clinical researches, more non- surrogate outcomes should be reported, such as maternal and neonatal mortality and morbidity. (Funded by the National Natural Science Foundation of China, and the Science & Technology Department of Sichuan Province, China.)
Article Type
Systematic Review and Meta-Analysis
Declaration of Interests
The authors declare no other potential conflicts of interest for this work.
Acknowledgements
This study was funded by the National Natural Science Foundation of China (No. 81170077) and Science & Technology Department of Sichuan Province (No. 2017SZ0147).
This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.