Spinal Versus General Anaesthesia Fetal & Maternal Complications

86 Pages·2004·0.47 MB·English

University Of Khartoum

Faculty Of Medicine

Postgraduate Medical Studies Board

Spinal Versus General Anaesthesia Fetal & Maternal
Complications

By :

Dr: Traig Hashim Hamid

M.B.B.S Friendship University (Moscow)
U.S.S.R

A thesis submitted in partial fulfillment for the degree of Clinical M.D.
in Obstetrics & Gynecology

Dec.2002

Supervisor:

Dr.Bashir El-Geili

M.B.B.S,C.M.D (KH)
**To my family and all patients**

**Who participated in this study**
Acknowledgement
Abstract 1
Chapter One
Introduction 5
Litterateur review 8
Objectives 53
Chapter Two
Patients & Methods 54
Chapter Three

Result 56
Chapter Four

Discussion 62
Conclusion 69
Recommendations 70
References 72
Tale & Figures 80
Appendix
There are no words invented to express my feeling
towards those who enlightened my way throughout the
period of conducting this study, I wish to acknowledge
my debts to my supervisor Dr.Bashir El-Geili Assistant
Professor & Head Department of Obs.& Gyn. U of K
for his continuos help and guidance, and I wish to thank
him for his suggestions, criticism and valuable advice
throughout the period of this study .
I wish to express my appreciation and indebtedness
to Dr. Nemat El-Awad Associated Professor of
Anaesthesia U of K for her support, encouragement and
continuos advice in spite of her extensive work .
I would like to thank Dr. Adil Hassan consultant
anesthetist for his advice and unlimited help….
And thanks to all obstetricians and gynecologist, from
whom I gained my little experience .
3/
Abstract
This study was carried out on 200 pregnant women, with
uncomplicated pregnancy, planned for elective cesarean
sections in Omdurman maternity hospital for Jan.2001 up
to Jun 2001. Half of the patients were operated under
spinal anesthesia (group A), while the others operated
under general anesthesia (group B). The patients were
chosen randomly.
This study was aimed at evaluating the complications of
spinal anesthesia to the pregnant woman and her neonate
in comparison with general anesthesia.
This study showed that spinal puncture has less
complications in comparison with intubation, and there
was no change in the fetal heart rate after conduction of
both types of anesthesia.
Apgar score was high (10) in neonates of group (A),
while it was low (8% scored 6 and 62% scored 8) at 1
min., with improvement at 5 min. (20% scored 8) in-
group (B). Apgar score was the same (10) in both groups
at 10 min.
It was observed that majority of patients 43% in group
(B) required analgesia at 30 min. postoperatively,
compared with 31% at 80 min. in group (A), indicating
that local anaesthetic drugs have good post operative
analgesia.
It was found that 22 gauge spinal needle associated with
increased rate of post-dural puncture headache 18% in
group (A), the same percentage was found with laryngeal
pain in group (B).
It was found that there was low rate of post- operative
infection is both groups, and no anaesthetic death was
reported.
The study showed that spinal anaesthesia is cheaper
(8.433 SP) than general anasthesia (29.894 SP), and has
wide acceptance.
ﺔﺤﻭﺭﻁﻷﺍ ﺹﺨﻠﻤ

ﺀﺍﺭﺠﻹ ﺍﻭﺭﻀﺤ ﺔﻀﻴﺭﻤ ﻲﺘﺌﺎﻤ ﻲﻠﻋ ﺔﻴﻠﺒﻘﺘﺴﻤﻟﺍ ﺔﺴﺍﺭﺩﻟﺍ ﻩﺫﻫ ﺕﻴﺭﺠﺃ
ﺎﻤ ﺓﺭﺘﻔﻟﺍ ﻲﻓ ﺩﻴﻟﻭﺘﻠﻟ ﻥﺎﻤﺭ ﺩﻤﺃ ﻲﻔﺸﺘﺴﻤﺒ (ﺓﺩﺭﺎﺒ) ﺔﻠﺠﻌﺘﺴﻤ ﺭﻴﻏ ﺔﻴﺭﺼﻴﻗ ﺕﺎﻴﻠﻤﻋ
2001 2001
ﺕﺎﻴﻠﻤﻋ ﻡﻬﻟ ﺕﻴﺭﺠﺃ ﻰﻀﺭﻤﻟﺍ ﻑﺼﻨ . ﻡ ﻭﻴﻨﻭﻴ ﻰﻟﺇ ﺭﻴﺎﻨﻴ ﻥﻴﺒ
ﺔﻴﻠﻤﻌﻟﺍ ﻡﻬﻟ ﺕﻴﺭﺠﺃ ﺭﺨﻵﺍ ﻑﺼﻨﻟﺍﻭ ( ﺃ ﺔﻋﻭﻤﺠﻤ )ﻲﻔﺼﻨﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﺕﺤﺘ ﺔﻴﺭﺼﻴﻗ
ﺽﺭﻐﻟﺍ. ﺎﻴﺌﺍﻭﺸﻋ ﻰﻀﺭﻤﻟﺍ ﺭﺎﻴﺘﺨﺍ ﻥﺎﻜﻭ ... ( ﺏ ﺔﻋﻭﻤﺠﻤ) لﻤﺎﻜﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﺕﺤﺘ
ﺎﻬﻨﻴﻨﺠﻭ لﻤﺎﺤﻟﺍ ﺓﺃﺭﻤﻟﺍ ﻲﻠﻋ ﻲﻔﺼﻨﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﺕﺎﻔﻋﺎﻀﻤ ﻡﻴﻘﺘ ﻭﻫ ﺔﺴﺍﺭﺩﻟﺍ ﻩﺫﻫ ﻥﻤ
. لﻤﺎﻜﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ
ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ لﻗﺍ ﺕﺎﻔﻋﺎﻀﻤ ﻱﺭﻬﻅﻟﺍ لﺯﺒﻤﻠﻟ ﻥﺃ ﺩﺠﻭ ﺔﺴﺍﺭﺩﻟﺍ ﻩﺫﻫ ﻥﻤ
ﻼﻜ ﻲﻓ ﻥﻴﻨﺠﻟﺍ ﺏﻠﻗ ﺕﺎﺒﺭﻀ لﺩﻌﻤ ﻲﻓ ﺭﻴﻴﻐﺘ ﺩﺠﻭﻴ ﻻ ﻪﻨﺍ ﺎﻤﻜ ، ﻲﻤﺎﻗﺭﻟﺍ ﺏﻴﺒﻨﺘﻟﺍ
. لﻤﺎﻜﻟﺍﻭ ﻲﻔﺼﻨﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﻲﺘﻟﺎﺤ
10
ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ (ﺃ) ﺔﻋﻭﻤﺠﻤﻟﺍ ﻲﻓ ﺔﻨﺠﻸﻟ ( ) ﺎﻴﻟﺎﻋ ( ﺭﺎﻘﺒﺃ) لﺩﻌﻤ ﻥﺃ ﺩﺠﻭ
8 62 6 8
ﻥﺴﺤﺘﻭ لﺩﻌﻤﺒ % ﻭ لﺩﻌﻤﺒ % ﺔﺒﺴﻨﺒ ﻰﻟﻭﻷﺍ ﺔﻘﻴﻗﺩﻟﺍ ﻲﻓ لﺩﻌﻤﻟﺍ ﺽﺎﻔﺨﻨﺍ
8 20
ﻥﺎﻜﻭ (ﺏ) ﺔﻋﻭﻤﺠﻤﻟﺍ ﻲﻓ لﺩﻌﻤﺒ % ﺔﺒﺴﻨﺒ ﻕﺌﺎﻗﺩ ﺔﺴﻤﺨ ﻲﻓ لﺩﻌﻤﻟﺍ
10
.ﻕﺌﺎﻗﺩ ﺓﺭﺸﻋ ﻲﻓ ( ) لﺩﻌﻤ ﻥﻴﺘﻋﻭﻤﺠﻤﻠﻟ
43
ﺍﻭﺒﻟﺎﻁ (ﺏ) ﺔﻋﻭﻤﺠﻤﻟﺍ ﻲﻓ ( % )ﻲﻀﺭﻤﻟﺍ ﺔﻴﺒﻟﺎﻏ ﻥﺃ ﺔﺴﺍﺭﺩﻟﺍ ﺕﺩﺠﻭ
80 31 30
ﻲﻓ ﺔﻘﻴﻗﺩ ﻲﻓ ( %)ـﺒ ﺔﻨﺭﺎﻘﻤ ﺔﻴﻠﻤﻌﻟﺍ ﺩﻌﺒ ﺔﻘﻴﻗﺩ ﻲﻓ ﻡﻬﻤﻻﺁ ﻥﻴﻜﺴﺘﺒ
ﺩﻌﺒ ﺎﻤ ﻡﻻﺁ ﻥﻴﻜﺴﺘﻟ لﻭﻁﺃ ﺓﺭﺘﻓ ﺀﺎﻁﻋﺇ ﻲﻌﻀﻭﻤﻟﺍ ﺭﺩﺨﻤﻟﺍ ﺓﺭﺩﻘﻟ ﻙﻟﺫﻭ (ﺃ) ﺔﻋﻭﻤﺠﻤﻟﺍ
ﺔﻴﻠﻤﻌﻟﺍ
ﻱﺭﻬﻅﻟﺍ لﺫﺒﻟﺍ ﺩﻌﺒ ﺎﻤ ﻉﺍﺩﺼ ﻥﻤ ﻯﻭﻜﺸﻟﺍ لﺩﻌﻤ ﻉﺎﻔﺘﺭﺍ ﺕﺩﺠﻭ ﺔﺴﺍﺭﺩﻟﺍ
22 18
ﺕﺩﺠﻭ ﺎﻤﻜ (ﺃ) ﺔﻋﻭﻤﺠﻤﻟﺍ ﻲﻓ ( ) ﺱﺎﻘﻤ ﻱﺭﻬﻅﻟﺍ لﺫﺒﻟﺍ ﺓﺭﺒﺇ لﺎﻤﻌﺘﺴﺎﺒ ( %)
ﺩﻌﺒ ﺎﻤ ﺕﺎﻨﺎﺘﻨﺍ لﺩﻌﻤ ﻥﺃ ﺩﺠﻭ. (ﺏ) ﺔﻋﻭﻤﺠﻤﻟﺍ ﻲﻓ ﺓﺭﺠﻨﺤﻟﺍ ﻡﻻﺁ ﻊﻤ ﺔﺒﺴﻨﻟﺍ ﺱﻔﻨ
ﺔﺠﻴﺘﻨ ﻩﺎﻓﻭ ﺕﻻﺎﺤ ﺩﺠﻭﺘ ﻻ ﺎﻤﻜ (ﺏ)ﻭ (ﺃ) ﻥﻴﺘﻋﻭﻤﺠﻤﻟﺍ ﻼﻜ ﻲﻓ ﺎﻀﻔﺨﻨﻤ ﺔﻴﻠﻤﻌﻟﺍ
. ﺭﻴﺩﺨﺘﻟﺍ ﺕﺎﻔﻋﺎﻀﻤ
8.433
( ﻲﻨﺍﺩﻭﺴ ﻪﻴﻨﺠ ) ﺔﻔﻠﻜﺘ لﻗﺍ ﻲﻔﺼﻨﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﻥﺎﺒ ﺔﺴﺍﺭﺩﻟﺍ ﺕﺩﺠﻭ
29.894
ﺭﻴﺩﺨﺘﻟﺍ ﻥﺎﺒ ﺔﺴﺍﺭﺩﻟﺍ ﺕﺩﺠﻭ . ( ﻲﻨﺍﺩﻭﺴ ﻪﻴﻨﺠ ) لﻤﺎﻜﻟﺍ ﺭﻴﺩﺨﺘﻟﺎﺒ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ
. لﻤﺎﻜﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﻻﻭﺒﻗ ﺭﺜﻜﺍ ﻲﻔﺼﻨﻟﺍ
لﻤﺎﺤﻟﺍ ﺓﺃﺭﻤﻠﻟ لﻗﺍ ﺕﺎﻔﻋﺎﻀﻤ ﻲﻔﺼﻨﻟﺍ ﺭﻴﺩﺨﺘﻠﻟ ﻥﺃ ﺩﺠﻭ ﺔﺴﺍﺭﺩﻟﺍ ﻩﺫﻫ ﻥﻤ
. ﺔﻔﻠﻜﺘ لﻗﺍﻭ ﺎﻴﻨﻘﺘ لﻬﺴﺍ ﻪﻨﺍ ﺎﻤﻜ .. لﻤﺎﻜﻟﺍ ﺭﻴﺩﺨﺘﻟﺍ ﻊﻤ ﺔﻨﺭﺎﻘﻤﻟﺎﺒ ﺎﻬﻨﻴﻨﺠﻭ
ﺭﻴﺩﺨﺘﻟﺍ ﺕﺤﺘ ﺔﺠﻤﺭﺒﻤﻟﺍ ﺔﻴﺭﺼﻴﻘﻟﺍ ﺕﺎﻴﻠﻤﻌﻟﺍ ﺀﺍﺭﺠﺈﺒ ﺔﺴﺍﺭﺩﻟﺍ ﻲﺼﻭﺘﻭ
ﻱﺭﻬﻅﻟﺍ لﺫﺒﻟﺍ ﺓﺭﺒﺇ ﻡﺍﺩﺨﺘﺴﺎﺒ ﻲﺼﻭﺘ ﺎﻤﻜ ﻙﻟﺫ ﻊﻨﻤﻴ ﺎﻤ ﻙﺎﻨﻫ ﻥﻜﻴ ﻡﻟ ﺎﻤ ﻲﻔﺼﻨﻟﺍ
27
ﺎﻴﺌﺎﻗﻭ ﻉﺍﺩﺼﻟﺍ ﺕﺎﻨﻜﺴﻤ ﻡﺍﺩﺨﺘﺴﺍﻭ لﺫﺒﻟﺍ ﺩﻌﺒ ﺎﻤ ﻉﺍﺩﺼ ﺔﺒﺴﻨ لﻴﻠﻘﺘﻟ ( ) ﺱﺎﻘﻤ

. ﻯﻭﻜﺸﻟﺍ ﻩﺫﻬﺒ ﺦﻴﺭﺎﺘ ﻡﻬﻟ ﻥﻴﺫﻠﻟ
Introduction
Caesarian section has become more and more
common in the developing countries. Rates as high as
20-25% are often seen- especially in large hospitals (1)
while the c/s rate is a little bit raised in some large
hospitals, it was found that the rate has rapidly increase
in other hospitals. The outstanding example for that is
Suba university hospital.
Since the fetal- maternal unit was established in
S.U.H. in 2000, S.U.H become the best tertiary center in
Sudan. Fetal maternal unit provides optimal follow-up
for both, the mother and the fetus , and determines the
optimal time foe surgical intervention the optimal time
for surgical intervention , for the sake of the mother and
the fetus as well. The presence of an excellent neonatal
care unit with competent staff increases the rate of in-
utero transfer from other hospitals, making S.U.B a
central referral hospital for the most high risk patients
requiring delivery by cesarean section and neonatal care.
High risk patient , are those with P.I.H diabetes,
IUG R, prematurity etc..