Dick W, Traub E, Kraus H, Töllner U, Burghard R, Muck J
Department of Anaesthesiology, University Hospital of Mainz, Germany.
Eur J Anaesthesiol. 1992 Jan;9(1):15-21.
Forty-seven healthy parturients undergoing elective Caesarean section were randomly allocated to either general anaesthesia (n = 24) or epidural anaesthesia (n = 23) under standardized anaesthetic and surgical conditions. Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate. Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia. The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia. Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group. Twenty-four hours and 7 days after delivery all infants of both groups were completely normal. At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group, due to higher inspired oxygen concentrations. Comparable results were obtained in umbilical PO2 venous values; lower pH values, however, were observed in the umbilical artery after general anaesthesia. There were no significant differences in the glucose levels between the groups. A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group, but not in the epidural group. Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome. Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome. Whether this is also true for critical conditions cannot be concluded from this study.
47名择期剖宫产的健康产妇在标准化麻醉和手术条件下被随机分为全身麻醉组（n = 24）或硬膜外麻醉组（n = 23）。硬膜外麻醉组中有7名产妇在新生儿娩出后需要额外的全身镇痛或镇静。全身麻醉后，24名新生儿中有9名1分钟阿氏评分低于7分，而硬膜外麻醉后只有3/23。硬膜外麻醉后婴儿恢复正常肤色的时间为2.2分钟，全身麻醉后为4.9分钟。全身麻醉组的24名新生儿中有3名表现出肌张力低下的倾向，而硬膜外麻醉组只有1名。分娩后24小时和7天，两组所有婴儿均完全正常。分娩时，由于吸入氧浓度较高，全身麻醉组产妇的动脉血氧分压高于硬膜外麻醉组。脐静脉血氧分压值也得到了类似的结果；然而，全身麻醉后脐动脉的pH值较低。两组之间的血糖水平没有显著差异。全身麻醉组子宫切开至分娩间隔与新生儿1分钟阿氏评分之间存在显著相关性，而硬膜外麻醉组则没有。我们的研究没有显示子宫切开至分娩间隔或手术开始至分娩间隔对新生儿结局有影响。在正常情况下，剖宫产中硬膜外麻醉在新生儿结局方面优于全身麻醉。本研究无法得出在危急情况下是否也是如此的结论。
