A Comparative Study on the Post Operative Outcome of Subarachnoid Block and General Anaesthesia in Parturients Complicated with Eclampsia: A Prospective Study

Introduction: It is a well-known fact that fatality following eclampsia remains high especially in developing countries with limited facilities. Ideal anaesthetic technique for caesarean delivery in stable eclamptics is yet to be determined. Aim and Objectives: To study the postoperative outcome of the subarachnoid block and general anaesthesia in parturients complicated with eclampsia. Methods: Sixty two stable eclamptic parturients scheduled for the emergency caesarean section Original Research Article Michael et al.; JAMMR, 27(2): 1-11, 2018; Article no.JAMMR.41713 2 under anaesthesia were randomised to receive either general anaesthesia or spinal anaesthesia. Patients in spinal anaesthesia (SA group) had 0.5% intrathecal hyperbaric bupivacaine. While those in general anaesthesia (GA group), were induced with thiopentone 4mg kg -1 . Suxamethonium 1.5 mg kg was given to facilitate orotracheal intubation with the cuffed tube. Patients' perioperative findings were recorded. Results: The risk of developing postoperative respiratory failure was significantly higher in patients with general anaesthesia (9; 29%) than those with spinal anaesthesia (0; 0%) (P=0.040, RR=0.053, 95% CI= 0.003-0.858). There was a higher risk of postoperative ventilation in patients in GA (9; 29%) than in SA (0; 0%) (P=0.040, RR=0.053, 95% CI= 0.003-0.858). Neonates who were delivered under spinal anaesthesia were also observed to have better recovery scores. The proportion of patients who stayed longer than eight days in the hospital was significantly higher in GA (P=0.0004, RR=2.0, 95% CI= 1.260-3.190). Conclusion: Eclamptic parturients who underwent Caesarean Section under spinal anaesthesia had significant better postoperative outcome than those who had general anaesthesia. Neonates that were delivered under spinal anaesthesia were also observed to have better recovery scores.

[1]  C. Nwachukwu,et al.  Evolving pattern of spinal anaesthesia in stable eclamptic patients undergoing caesarean section at University of Benin Teaching Hospital, Benin, Nigeria. , 2014, Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria.

[2]  S. Parthasarathy,et al.  Anesthetic management of a patient presenting with eclampsia , 2013, Anesthesia, essays and researches.

[3]  Anindya Das,et al.  Experience of a low‐dose magnesium sulfate regimen for the management of eclampsia over a decade , 2013, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[4]  N. Mistry,et al.  Availability of Treatment for Eclampsia in Public Health Institutions in Maharashtra, India , 2013, Journal of health, population, and nutrition.

[5]  S. Feng,et al.  Delayed recovery from general anaesthesia in a parturient after magnesium toxicity. , 2013, Anaesthesia and intensive care.

[6]  Y. D. Buowari,et al.  Progression of pre-eclampsia to eclampsia under spinal anaesthesia , 2012, Advanced biomedical research.

[7]  L. Duley,et al.  A systematic review of maternal and infant outcomes following magnesium sulfate for pre‐eclampsia/eclampsia in real‐world use , 2012, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[8]  Ranju Singh,et al.  Spinal anesthesia for lower segment Cesarean section in patients with stable eclampsia. , 2011, Journal of clinical anesthesia.

[9]  S. Dasgupta,et al.  Comparison of neonatal outcome in women with severe pre-eclampsia undergoing caesarean section under spinal or general anaesthesia. , 2011, Journal of the Indian Medical Association.

[10]  E. Agida,et al.  Pregnancy outcome in eclamptics at the University of Abuja Teaching Hospital, Gwagwalada, Abuja: a 3 year review. , 2010, Nigerian journal of clinical practice.

[11]  J. A. Turner,et al.  Diagnosis and management of pre-eclampsia: an update , 2010, International journal of women's health.

[12]  M. K. Basu,et al.  Randomised Comparison of General Anaesthesia & Subarachnoid Block for Caesarean Delivary in Pregnancies Complicated by Eclampsia , 2009 .

[13]  J. Tukur.  The use of magnesium sulphate for the treatment of severe pre-eclampsia and eclampsia. , 2009, Annals of African medicine.

[14]  J. Tukur,et al.  Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria. , 2007, Annals of African medicine.

[15]  M. Ijaiya,et al.  Maternal mortality in a Nigerian teaching hospital - a continuing tragedy , 2007, Tropical doctor.

[16]  M. Suresh,et al.  Airway problems in pregnancy , 2005, Critical care medicine.

[17]  B. Sibai.  Diagnosis, prevention, and management of eclampsia. , 2005, Obstetrics and gynecology.

[18]  O. Nafiu,et al.  Anaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an "impossible" airway. , 2004, International journal of obstetric anesthesia.

[19]  N. Sathiakumar,et al.  Maternal mortality in Northern Nigeria: a population-based study. , 2003, European journal of obstetrics, gynecology, and reproductive biology.

[20]  M. Douglas,et al.  Platelets, the parturient and regional anesthesia , 2001 .

[21]  J. Moodley,et al.  Epidural compared with general anaesthesia for caesarean delivery in conscious women with eclampsia , 2001, BJOG : an international journal of obstetrics and gynaecology.

[22]  I. Wijesurendra.  Spinal haematoma following epidural anaesthesia in a patient with eclampsia , 1999, Anaesthesia.

[23]  J. Downing,et al.  GENERAL ANAESTHESIA IN MOTHERS WITH SEVERE PRE-ECLAMPSIA/ECLAMPSIA , 1987 .

[24]  C. Houghton.  Low Spinal Block in Eclampsia , 1951 .

[25]  R. Paramore.  A CASE OF ECLAMPSIA TREATED WITH SPINAL ANAESTHESIA * , 1930, British medical journal.