Perinatal outcome of crash caesarean section under neuraxial anesthesia versus general anesthesia: a seven-year retrospective analysis

Abstract Objective The crash cesarean section (CS), which keeps extremely life-threatening to maternals or fetus, seems to be performed within adequate time horizon for the avoidance of negative feto-maternal denouement. The effective and vigilant technique of anesthesia remains vital for crash cesarean delivery. This study, hence, aims to validate the impact of various anesthesia tactics on the maternal as well as neonatal outcomes. Method This was a retrospective cohort study of parturient with the indication for crash CS with the assistance of general or neuraxial anesthesia during the period of January 2015 and July 2021 in our institution. The 1min Apgar score as primary outcome was documented. Secondary outcomes composing 5 min Apgar score, DDI, OAII, duration of operation, length of hospitalization, height and weight of newborn, use of vasopressors, blood loss were also measured. Results Of the total 536 subjects incorporated in the analysis, 337 crash CS were performed under general anesthesia (GA), 137 under epidural anesthesia (EA) and 65 under combined spinal-epidural anesthesia (CSE), respectively. The Apgar score of 1 min and 5 min in newborn receiving general anesthesia were lower than those under intraspinal anesthesia and no difference was found between EA and CSEA. The decision-to-delivery interval (DDI) of parturients under GA, EA, and CSE was 7[6,7], 6[6,7], and 14[11.5,20.5], respectively. DDI as well as decision to incision interval (DII) of GA and EA were shorter than CES, among which there was a similarity in DDI and DII between GA and EA. Compared to GA, the onset of anesthesia to incision interval (OAII) of intraspinal anesthesia was extended significantly. The birth height and weight of neonates from EA seem to be superior to GA. Conclusion Epidural anesthesia did not exploited negative impact on neonatal and maternal outcomes as compared to general anesthesia and could be utilized as an alternative to general anesthesia in crash cesarean section; in addition, the DDI of crash cesarean section could be achieved within 15 minutes under general or epidural anesthesia in our institution.