The assessment of optimal anesthesia technique for cesarian section and its clinical effects on mother and newborns.

Seventy-five ASA II parturients who did not have endocrine, cardiopulmonary, renal, hepatic or neuromuscular diseases, and undergo cesarean section for their first delivery, and in their 38th week of the pregnancy, without preeclampsia or fetal problems (fetal abnormalities, growth retardation, umbilical artery anomalies, malposition) were included. Patients were randomly divided into three groups (n=25): general anesthesia, epidural anesthesia and spinal anesthesia. The randomization was performed using sequentially numbered, opaque sealed envelopes. In General anesthesia group, patients received 5 mg/kg thiopental sodium and 0.6 mg/kg rocuronium bromide intravenous for induction of anesthesia. After the patients were intubated, anesthesia was maintained with 30% O2, 70% N2O and 1-2% sevoflurane. Mechanical ventilation was performed by setting the tidal volume at 6-8 mL/kg and the respiratory rate at 8-10/minute. Patients were ventilated with 100% O2 during the period between placement of bladder retractor and cord clamping after delivery. Neuromuscular block was antagonized with 0.03-0.07 mg/kg neostigmine and 0.02 mg/kg atropine sulfate intravenous. Patients in Epidural anesthesia group were administered 16 mL of 0.5% bupivacaine + 3 mg morphine in lateral position through the L4-L5 intervertebral space using an 18 G Touhy needle by the loss of resistance technique. An epidural catheter was left 5 cm in the epidural space. In Spinal anesthesia group, 3 mL of 0.5% bupivacaine with 200 µg morphine through the L4-L5 intervertebral space by a 25 G spinal needle (Quincke) in lateral decubitus position. In Group Epidural anesthesia and Spinal anesthesia, surgery was started by the time the sensory block reached the T4 dermatome. The level of sensory block was assessed by the ‘Pinprick’ test. Motor block was assessed using the Bromage Scale. Mean arterial pressure, heart rate and SpO2 values were recorded before and after anesthesia induction, and at the 1st, 5th, 10th, 20th, and 40th minutes of surgical incision. Decrease of heart rate below 30% of the basal values was considered as bradycardia and 0.5 mg atropine was administered. When mean arterial pressure showed a decrease of more than 30%, it was regarded as hypotension and ephedrine 10 mg was injected intravenous as a bolus dose. Skin-uterine incision time, uterine incision-delivery time, perioperative bleeding, crystalloid requirement, total amount of intravenous ephedrine requirement were recorded. The time of defecation and mobilization, discharge of mother and the time to first breastfeeding from delivery of the newborn were also recorded. The time when the postoperative pain score (according to Numeric Rating Scale), 0= no pain, 10= extreme pain) increased by 3 or higher was recorded as the first analgesia requirement time. General anesthesia and spinal anesthesia groups were administered 1 mg/kg meperidine intravenous every 6 hours and 1 g paracetamol intravenous every 8 hours. The epidural anesthesia group received a mixture of 3 mg morphine and 15 mg bupivacaine in a volume of 9 cc through the epidural catheter. A pediatrician examined the newborns. The newborns were monitored and their SpO2 and APGAR scores were recorded at the 1st, 5th and 10th minutes. Blood gas analysis obtained from umblical ven was examined. In the postoperative period, time to first breastfeeding of the newborn, phototherapy requirement, level of bilirubin, weight loss of the newborn at the 24th and 48th hours and the need at birth for free O2, positive-pressure ventilation, chest compressions, intubation and intensive care admission were also recorded.