School of Medicine, University of Glasgow, Glasgow, UK
Department of medical physics, NHS Greater Glasgow and Clyde, Glasgow, UK.
Reg Anesth Pain Med. 2021 Jun;46(6):482-489. doi: 10.1136/rapm-2020-102441. Epub 2021 Apr 8.
The fetus is vulnerable to maternal drug exposure. We determined associations of exposure to spinal, epidural, or general anesthesia on neonatal and childhood development outcomes during the first 1000 days of life.
Population-based study of all singleton, cesarean livebirths of 24+0 to 43+6 weeks gestation between January 2007 and December 2016 in Scotland, stratified by urgency with follow-up to age 2 years. Models were adjusted for: maternal age, weight, ethnicity, socioeconomic status, smoking, drug-use, induction, parity, previous cesarean or abortion, pre-eclampsia, gestation, birth weight, and sex.
140 866 mothers underwent cesarean section (41.2% (57,971/140,866) elective, 58.8% (82,895/140,866) emergency) with general anesthesia used in 3.2% (1877/57,971) elective and 9.8% (8158/82,895) of emergency cases. In elective cases, general anesthesia versus spinal was associated with: neonatal resuscitation (crude event rate 16.2% vs 1.9% (adjusted RR 8.20, 95% CI 7.20 to 9.33), Apgar <7 at 5 min (4.6% vs 0.4% (adjRR 11.44, 95% CI 8.88 to 14.75)), and neonatal admission (8.6% vs 4.9% (adjRR 1.65, 95% CI 1.40 to 1.94)). Associations were similar in emergencies; resuscitation (32.2% vs 12.3% (adjRR 2.40, 95% CI 2.30 to 2.50)), Apgar <7 (12.6% vs 2.8% (adjRR 3.87, 95% CI 3.56 to 4.20), and admission (31.6% vs 19.9% (adjRR 1.20, 95% CI 1.15 to 1.25). There was a weak association between general anesthesia in emergency cases and having ≥1 concern noted in developmental assessment at 2 years (21.0% vs 16.5% (adjRR 1.08, 95% CI 1.01 to 1.16)).
General anesthesia for cesarean section, irrespective of urgency, is associated with neonatal resuscitation, low Apgar, and neonatal unit admission. Associations were strongest in non-urgent cases and at term. Further evaluation of long-term outcomes is warranted.
胎儿易受到母体药物暴露的影响。我们旨在确定在生命的最初 1000 天中，接受脊髓、硬膜外或全身麻醉对新生儿和儿童发育结局的影响。
这是一项基于人群的研究，纳入了 2007 年 1 月至 2016 年 12 月期间苏格兰所有 24+0 至 43+6 周龄、行择期剖宫产分娩的单胎活产儿，按紧急程度分层，随访至 2 岁。模型调整了：母亲年龄、体重、种族、社会经济地位、吸烟、药物使用、引产、产次、既往剖宫产或流产、子痫前期、孕周、出生体重和性别。
140866 名母亲接受了剖宫产术（41.2%（57971/140866）为择期，58.8%（82895/140866）为急诊），其中 3.2%（1877/57971）的择期手术和 9.8%（8158/82895）的急诊手术使用了全身麻醉。在择期手术中，全身麻醉与脊髓麻醉相比：新生儿复苏（粗发生率 16.2% vs 1.9%（调整 RR 8.20，95%CI 7.20 至 9.33））、5 分钟时 Apgar<7（4.6% vs 0.4%（调整 RR 11.44，95%CI 8.88 至 14.75））和新生儿住院（8.6% vs 4.9%（调整 RR 1.65，95%CI 1.40 至 1.94））。在急诊手术中也存在相似的关联；复苏（32.2% vs 12.3%（调整 RR 2.40，95%CI 2.30 至 2.50））、Apgar<7（12.6% vs 2.8%（调整 RR 3.87，95%CI 3.56 至 4.20））和住院（31.6% vs 19.9%（调整 RR 1.20，95%CI 1.15 至 1.25））。在急诊手术中使用全身麻醉与 2 岁时发育评估中存在≥1 项关注之间存在弱关联（21.0% vs 16.5%（调整 RR 1.08，95%CI 1.01 至 1.16））。
无论紧急程度如何，剖宫产时使用全身麻醉与新生儿复苏、低 Apgar 和新生儿病房入院有关。在非紧急病例中和足月时关联最强。需要进一步评估长期结局。
