Neonatal apgar score outcomes in spinal versus general anaesthesia at the university teaching hosipital (UTH) lusaka

Abstract

Background: The knowledge gap was from the fact that the type of anaesthetic drug administered during caesarean section can have effects on neonatal outcome like low Apgar score with most hospitals in developed countries now using more modern inhalational anaesthetic agents with fewer or no cardio-depressant effects e.g. Isoflurane or Sevoflurane. However at UTH, halothane is still being used for maintenance of general anaesthesia despite well documented cardio-respiratory depressant effects with very limited research done on its effects on neonatal Apgar score. The Apgar score is a means of rapid evaluation of the physical condition of infants shortly after birth. Thus this study investigated the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. Objective: The purpose of the study was to determine the effects of general anaesthesia with halothane versus spinal anaesthesia on neonatal Apgar score. Methods: This was a prospective observational cohort study conducted at the University Teaching Hospital (UTH) in Lusaka, Zambia. A questionnaire was used for data collection. This study involved 70 neonates. Of these, 54 were born from mothers that had undergone caesarean section under spinal anaesthesia and 16 from mothers that had undergone general anaesthesia. The data was analysed using SPSS version 16.0. Inferential analysis was conducted using logistic regression. Results: 20 neonates out of 54 (37%) in the spinal anaesthetic group had an Apgar score less than 8 at 1 minute. Out of the 16 neonates in the general anaesthesia group, 14 (87.5%) had Apgar score less than 8 at 1 minute. One (2%) neonate had an Apgar score less than 8 at 5 minutes in the spinal anaesthesia group while 53 neonates. At 5 minutes, 4 (25%) neonates had Apgar score less than 8 in the GA group. vi The linear logistic regression at 1 minute Shows that it’s over 11 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 11.9). The Apgar score at 1 minute in the Spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.002). The linear logistic regression at 5 minutes Shows that it’s over 17 times more likely to get a low Apgar with a general anaesthetic as compared to a spinal anaesthetic (OR 17.7). Further, the 5 minutes Apgar score in the spinal anaesthesia group was statistically significantly higher than the general anaesthesia group (p=0.014). Conclusion: With the results pointing to the fact that there is significant difference in neonatal Apgar score outcomes in spinal versus general anaesthesia, the researcher therefore rejected the null hypothesis. It is therefore inferred that spinal anaesthesia method has better neonatal outcomes by Apgar score measure than general anaesthesia method.