Key result
General anesthesia was associated with a significantly lower incidence of intraoperative hypotension compared to regional anesthesia during cesarean section (32.1% vs 46.5%, OR 0.545).
Why the study?
Cesarean section requires a safe and effective anesthetic technique for both mother and fetus, prompting a comparison of intraoperative hemodynamic safety between general and regional anesthesia.
Does general anesthesia reduce intraoperative hypotension compared to regional anesthesia in patients undergoing cesarean section?
Cohort (n=2,500)
No
Does general anesthesia reduce intraoperative hypotension compared to regional anesthesia in patients undergoing cesarean section?
Odds Ratio: 0.545 (95% CI 0.462–0.643)
Absolute Event Rate: 32.1% vs 46.5%
p-value: p=<0.001
General anesthesia provides better intraoperative hemodynamic stability with less hypotension than regional anesthesia during cesarean sections, though it is associated with increased blood loss and lower APGAR scores.
Background A cesarean section (CS) is common and requires a safe and effective anesthetic technique for the safety of both the mother and the fetus. This study aims to compare the intraoperative hemodynamic safety profile with general anesthesia (GA) and regional anesthesia (RA) and propose a superior technique for cesarean from the hemodynamic perspective. Methods After obtaining ethical committee approval, a retrospective closed cohort study was conducted on patients who underwent cesarean with GA and RA. This study was conducted at a tertiary-level university hospital in Oman from January 2015 to December 2019. The investigators collected maternal and fetal data (hypotension, bradycardia, blood loss, APGAR score, fetal mortality, complications, and length of stay) from January 2015 to December 2019. The primary outcome was the incidence of intraoperative hypotension, and the secondary outcomes studied were significant blood loss and APGAR score in both anesthesia techniques. Results A total of 2500 cesarean patients were studied, of whom 1379 received RA and 1121 received GA. The overall hypotension (systolic BP<90 mm Hg) rate observed was 40.1%; it was significantly lower with GA as compared to RA (32.1% versus 46.5%, respectively, P<0.001, OR 0.545, 95% CI 0.462 to 0.643). Consequently, the requirement for vasopressors was low with GA compared to RA (1.6% versus 23.1%, P<0.001, OR 0.054, 95% CI 0.034 to 0.088). Blood loss (>1 L) was remarkably higher in GA as compared to the RA (15.5% versus 8.9%, respectively, P<0.001, OR 1.916, 95% CI 1.499 to 2.448). APGAR scores were lower with GA than RA (2.8% versus 0.9%, P<0.001). Bradycardia and fetal mortality were almost equal in both groups. Conclusion GA is associated with significantly better hemodynamic stability during the cesarean section.
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Moosa et al. (2023) conducted a cohort in Cesarean section (n=2,500). General anesthesia vs. Regional anesthesia was evaluated on Incidence of intraoperative hypotension (systolic BP <90 mm Hg) (OR 0.545, 95% CI 0.462-0.643, p=<0.001). General anesthesia was associated with a significantly lower incidence of intraoperative hypotension compared to regional anesthesia during cesarean section (32.1% vs 46.5%, OR 0.545).
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