Li Chong-hua, Zhu Chun-xian, He Jing
Department of Newborn, Women's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 Mar;41(3):162-4.
To determine the safety of general anesthesia during cesarean section for neonates.
Singleton pregnant women for whom elective cesarean sections were planned after 37 gestation weeks were allocated to general anesthesia or epidural anesthesia. After preoxygenation, general anesthesia was induced with fentanyl (2.0 microg/kg), propofol (1.5 mg/kg) and vencuronium (0.08 mg/kg) followed by tracheal intubation. Oxygen-nitrous oxides (50%) was inhaled before delivery. Epidural anesthesia was performed at L(1 - 2) or L(2 - 3) on the left lateral decubitus position with 1.73% lidocaine carbonate (including 1:200 000 adrenaline). We studied arterial samples withdrawn from the infants 30 min after birth for the pH, PaO(2), PaCO(2), SPO(2) and Hct. Neonatal behavioral neurological assessments (NBNA) 3 - 5 days after birth were recorded.
(1) The pH, PaO(2), PaCO(2), SPO(2) and Hct in the general anesthesia group were 7.34 +/- 0.08, (40 +/- 11) mm Hg, (73 +/- 17) mm Hg, (96.8 +/- 1.0)%, and (53 +/- 5)%, while in the epidural anesthesia group were 7.35 +/- 0.05, (41 +/- 8) mm Hg, (71 +/- 17) mm Hg, (96.6 +/- 1.0)%, and (54 +/- 6)%. (2) NBNA scores: In the general anesthesia group, neonatal adaptive capacity, passive tone, active tone, primary reflexes and general status were 12.6 +/- 0.7, 7.2 +/- 0.7, 7.4 +/- 0.6, 5.6 +/- 0.8, and 5.9 +/- 0.3 respectively. While in the epidural anesthesia group they were 13.4 +/- 0.8, 7.3 +/- 0.5, 7.3 +/- 0.8, 5.6 +/- 0.6, and 5.9 +/- 0.3 respectively. No significant difference was seen (P > 0.05) between the general anesthesia group and the epidural anesthesia group in NBNA scores, mean pH, PaO(2), PaCO(2), SPO(2) and Hct of newborn infants.
It study suggests that general anesthesia for the elective cesarean section does not influence significantly the outcome of the newborn infants.
确定剖宫产术中全身麻醉对新生儿的安全性。
计划在妊娠37周后进行择期剖宫产的单胎孕妇被分配至全身麻醉组或硬膜外麻醉组。预充氧后，用芬太尼（2.0微克/千克）、丙泊酚（1.5毫克/千克）和维库溴铵（0.08毫克/千克）诱导全身麻醉，随后进行气管插管。分娩前吸入氧气-氧化亚氮（50%）。在左侧卧位L（1-2）或L（2-3）行硬膜外麻醉，使用1.73%碳酸利多卡因（含1:200 000肾上腺素）。我们研究了出生后30分钟从婴儿抽取的动脉血样本的pH值、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、脉搏血氧饱和度（SPO₂）和血细胞比容。记录出生后3-5天的新生儿行为神经评定（NBNA）。
（1）全身麻醉组的pH值、PaO₂、PaCO₂、SPO₂和血细胞比容分别为7.34±0.08、（40±11）毫米汞柱、（73±17）毫米汞柱、（96.8±1.0）%和（53±5）%，而硬膜外麻醉组分别为7.35±0.05、（41±8）毫米汞柱、（71±17）毫米汞柱、（96.6±1.0）%和（54±6）%。（2）NBNA评分：全身麻醉组新生儿适应能力、被动肌张力、主动肌张力、原始反射和一般状况分别为12.6±0.7、7.2±0.7、7.4±0.6、5.6±0.8和5.9±0.3。而硬膜外麻醉组分别为13.4±0.8、7.3±0.5、7.3±0.8、5.6±0.6和5.9±0.3。全身麻醉组与硬膜外麻醉组在新生儿NBNA评分、新生儿平均pH值、PaO₂、PaCO₂、SPO₂和血细胞比容方面均无显著差异（P>0.0）。
本研究表明，择期剖宫产的全身麻醉对新生儿结局无显著影响。
