Caesarean section anesthesia selection, spinal or general, and Apgar-score for newborn delivered with Caesarean section in Strumica

Anesthesia for caesarean section can be general and regional. General anesthesia is a state of unconsciousness and loss of protective reflexes as a result of administering one or more anesthetics by intravenous infusion. Regional caesarean section anesthesia can be spinal and epidural. Today with new local anesthetics, spinal anesthesia is an anesthesia of choice for caesarean section. The principle is to apply a local anesthetic to the spinal cord with reversible loss of nerve conduction resulting in muscle relaxation and analgesia. Apgar test is a method of assessing the health of a newborn immediately after birth that is done in the first and fifth minutes after birth and the result is called the Apgar score. The purpose of this paper is to compare the first-minute Apgar score in neonates delivered by caesarean section in terms of the type of anesthesia that has been used, general or spinal. The different types of anesthesia, the possibility for the patient to choose the type of anesthesia or that decision should be left to the anesthesiologist, are just some of the questions that arise at a time when the number of cesarean births is increasing. In this study is used data from the documentation of the Department of Anesthesiology and Resuscitation at PHI Strumica General Hospital on the type of anesthesia applied at each caesarean section and Apgar score of neonates born with these caesarean sections. Data have been collected since 2015, when general anesthesia was more prevalent and 2018, when spinal anesthesia is on the rise. 533 patients were included for 2015 and 496 for 2018. Inclusion Criteria - Indication of caesarean section: fetopelvic disproportion, hypertension, diabetes, preeclampsia, eclampsia, obesity. Exclusion criteria: fetal distress, placental abruption. Of all caesarean deliveries in 2015, 93.06% (496) had general anesthesia, the remaining 6.9% (37) were with spinal anesthesia. First-minute Apgar scores in infants born with caesarean section under general anesthesia were Apgar score -10 at 0.8%, 9 at 44.47%, 8 at 37.22% and lowest notched Apgar score 4 at 0.4%. First-minute Apgar score in infants delivered in spinal anesthesia was 10 in 10.81%, 9 in 70.27% 8 in 13.51%. In 2018, 13.9% (69) of the total number deliveries were done under general anesthesia and 86.08% (427) under spinal anesthesia. In neonates who underwent caesarean section under general anesthesia, the following values for Apgar score were obtained: There is no newborn with 10, 9 was at 20.29%, 8 at 56.52%. In neonates with spinal anesthesia, Apgar score in the first minute after delivery was 10 at 0.47%, 9 at 63.7%, 8 at 25.29% and lowest score- 5 at 0.47%. The improvement of anesthesiology practice, the new local anesthetics and informing the mothers about the safer type of anesthesia are important in the process of choosing the type of anesthesia during a caesarean section. The results only confirm that spinal anesthesia is safer for the mother and plays a role in higher Apgar score in the first minute in the newborn. The choice depends on many factors, and there is also the possibility for the mother to choose the type of anesthesia Keywords: Caesarean section, Spinal Anesthesia, General Anesthesia, Apgar Score