Comparison Between Spinal And Epidural Analgesia Versus General Anaesthsia For Elective Caesarean Section ” Effects On Maternal Stress Response And The Newborn Condition”

The present study was carried out to compare the endocrine andmetabolic response in healthy parturients subjected to delivery by caesarean section under three different technique of anaesthesia. The neonatal outcome and its correlation to anesthesia technique were investigated as the principle purpose of delivering an infant by elective caesarean section is to insure minimum risk to the mother and to optimise the infant’s condition.Thirty six parturients scheduled for an elective caesarean section (before the onset of labour pain) they were selected to be ASP I, with single, viable, full term fetus and with no obstetric complication. The parturients were subdivided into three groups according to technique of anesthesia.Group I : Received subarachnoid ”spinal” blockade from S5 to T6. Group II : Received extradural blockade from S5 to T6.Group III : Received general anesthesia with endotracheal intubation.The neoborn infants condition was assessed according to one and five-minute Apgar score, time to sustained respiration and the acid base status.Maternal hemodynamics :Mean arterial pressure showed a significant decreases in both group I and II and returned gradually towards normal (preoperative) values on the other hand it showed a significant increase immediately after induction and endotracheal intubation in group III then gradually returned towards preoperative values.As regard heart rate both group I and II showed a minimal increase although more in group II in contrast to the marked tachycardia occurred in group III immediately post induction.The rate pressure product showed a non-significant decrease in both group I and II, while group III showed a highly significant increase in rate pressure products.* Maternal biochemical results :Serum cortisol showed an increased levels at the immediate postoperative time in all the three group of study but the percentage of increase (compared to preoperative valves) were markedly higher in group III. The serum cortisol values had returned near preoperative levels. at 6- hours postoperative time in the three’ groups of study.Serum insulin showed a significant decrease at the immediate postoperative time in all of the three groups of study and these decreased values were continued to 6-hours postoperative time.Blood glucose showed increased values in the three groups of study but the amplitude of increase were markedly higher in group III. Six hours postoperatively the blood glucose showed a highly significant increase in either of the study groups.Plasma lactate had increased values in the three groups with a higher ratio of increase in group III then returned near preoperative levels at 6-hours post operatively.Neonatal biochemical results:There were a non significant correlation between maternal andneonatal biochemistry as regard serum cortisol serum insulin blood glucose and blood lactate.Neonatal condition :All three techniques of anesthesia have resulted a VIgOroUS conscious babies; the one minute Apgar score were over 7 all deliveries although best scores were in group III then group I then lastly group III.The five-minute Apgar score were become all above 9.5.The time to sustained respiration all were in the normal range (less than 80 seconds). although it was shortest in group II then groups I.The cord blood gases and acid base status were satisfactory with no acidosis, hypoxia or hypercarpia in all delivery outcome.