Korean J Anesthesiol.  2015 Oct;68(5):469-475. 10.4097/kjae.2015.68.5.469.

Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia

• Bakri MH
• Ismail EA
• Ghanem G
• Shokry M

• KMID: 2148655
• DOI: http://doi.org/10.4097/kjae.2015.68.5.469

Abstract

BACKGROUND
Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery.
METHODS
Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded.
RESULTS
Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality.
CONCLUSIONS
Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery.

Keyword

Apgar score; Cesarean section; General anesthesia; Sickle cell anemia; Spinal anesthesia

MeSH Terms

Acute Chest Syndrome
Anemia, Sickle Cell*
Anesthesia
Anesthesia, General*
Anesthesia, Spinal
Apgar Score
Blood Transfusion
Bradycardia
Cesarean Section*
Female
Hemodynamics
Humans
Hypotension
Infant
Infant Mortality
Infant, Newborn
Intensive Care Units
Intensive Care, Neonatal
Length of Stay
Mortality
Patient Satisfaction
Pilot Projects
Postoperative Nausea and Vomiting
Postpartum Period
Pregnancy
Vomiting