Departments of Anesthesiology and Reanimation, Duzce University School of Medicine, Duzce, Turkey.
Arch Gynecol Obstet. 2011 Nov;284(5):1059-65. doi: 10.1007/s00404-010-1783-8. Epub 2010 Dec 7.
Neonatal jaundice, a frequent problem in neonatology, can be influenced by many factors. Here, we sought to clarify the role of anesthesia and to compare the effects of various anesthesiological strategies on neonatal bilirubin levels during cesarean section.
We prospectively enrolled 167 ASA I-II status uncomplicated pregnant women who delivered by cesarean section as the study group. The patients were randomized based on anesthesiological strategy: inhalation (IA), spinal (SA), total intravenous (TIVA), and epidural anesthesia (EA) groups. Neonatal total (TB) and direct bilirubin (DB) levels at the 24th hour and 5th day of life and the need for phototherapy were compared between the groups.
Direct bilirubin levels at 24th hour of SA group and EA group were higher compared to IA group (p = 0.008). When DB levels at fifth day were compared, levels in group TIVA were significantly higher than group SA (p = 0.019). TB levels at fifth day in group TIVA were higher than SA and EA groups (p = 0.05). The percentage of newborns needing phototherapy did not differ significantly among groups, but was highest in the TIVA group (25%), followed by the IA (15%), EA (10%) and SA (7%) groups (p = 0.08).
EA and SA at cesarean section seem to be better among the four anesthesia techniques considering neonatal hyperbilirubinemia. Our findings are consistent with the idea that anesthesia may be a risk factor for hyperbilirubinemia. Although anesthesia may not significantly increase the need for interventions such as phototherapy, it may increase the burden of time, labor and cost.
新生儿黄疸是新生儿科常见的问题，可受到多种因素的影响。在此，我们旨在阐明麻醉的作用，并比较剖宫产时各种麻醉策略对新生儿胆红素水平的影响。
我们前瞻性纳入了 167 例 ASA I-II 级、无并发症的剖宫产孕妇作为研究对象。根据麻醉策略将患者随机分为吸入麻醉（IA）、脊髓麻醉（SA）、全凭静脉麻醉（TIVA）和硬膜外麻醉（EA）组。比较各组新生儿出生后 24 小时和第 5 天的总胆红素（TB）和直接胆红素（DB）水平以及光疗的需求。
SA 组和 EA 组新生儿出生后 24 小时的 DB 水平高于 IA 组（p = 0.008）。当比较第 5 天的 DB 水平时，TIVA 组的水平明显高于 SA 组（p = 0.019）。TIVA 组第 5 天的 TB 水平高于 SA 和 EA 组（p = 0.05）。各组新生儿需要光疗的比例无显著差异，但 TIVA 组最高（25%），其次是 IA 组（15%）、EA 组（10%）和 SA 组（7%）（p = 0.08）。
剖宫产时 EA 和 SA 似乎优于其他四种麻醉技术，因为它们能降低新生儿高胆红素血症的风险。我们的研究结果与麻醉可能是高胆红素血症的危险因素的观点一致。尽管麻醉可能不会显著增加光疗等干预措施的需求，但可能会增加时间、劳动力和成本的负担。
