Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections

Background & Objective: There is an increased ratio of cesarean sections (CS) compared to normal deliveries the world over. Both general and regional anesthetic techniques are in practice for CS. Limited information is available on the determination of blood cholinesterase (ChE) activity in conjunction with oxidative stress biomarkers after the CS. The purpose of the present study was to determine and compare the plasma and erythrocyte ChE activity as well as malondialdehyde (MDA) level and total antioxidant status in pregnant women before anesthesia and after the use of general anesthesia (GA) or spinal anesthesia (SA) for elective CS. Methodology: A pre-post study was conducted on 102 full-term pregnant women, who underwent elective CS in four hospitals at Duhok (Iraq) from January 2022 to July 2022. GA with propofol and SA with bupivacaine 0.5% were administered to 52 and 50 women, respectively. Maternal blood samples before anesthesia and after the completion of operation were assayed for the ChE activity in the plasma and erythrocytes, and plasma oxidative stress biomarkers malondialdehyde and total antioxidant status. Results: Plasma ChE activity significantly decreased in the GA and SA groups after the cesarean-deliveries compared to the corresponding pre-anesthetic values. The plasma MDA level in both GA and SA groups, but not the total antioxidant status, was significantly reduced. Estimation of the odds ratio and the relative risk indicated that a risk factor is associated with the reduced plasma ChE activity in women after the CS when the general anesthetic propofol is used. Conclusion: Both general anesthesia with propofol and spinal anesthesia with bupivacaine inhibited plasma cholinesterase activity and reduced oxidative stress biomarker malondialdehyde after the cesarean sections. Abbreviations: CS - Cesarean section; ChE: Cholinesterase; EChE: Erythrocyte Cholinesterase; MDA: Malondialdehyde; OS: Oxidative Stress; PChE: Plasma ChE; TAS: Total Antioxidant Status. Key words: Anesthesia, Spinal; Cesarean section; General anesthesia; Malondialdehyde; Oxidative stress Citation: Karam RS, Mohammad FK. Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections. Anaesth. pain intensive care 2023;27(3):396−404; DOI: 10.35975/apic.v27i3.2244 Received: March 23, 2023; Reviewed: May 06, 2023; Accepted: May 09, 2023