Evaluation der anästhesiologischen Verfahren bei Sectio caesarea

Introduction: In April 2001 in the women’s hospital of the Philipps University Marburg spinal anesthesia was introduced as a new procedure for anesthesia in cesarean section. This was the reason to examine whether the percentage of general anesthesia in cesarean section could be lowered by this method, whether the indication for cesarean section had an influence on the selection of anesthesia procedure, as well as to describe the influence on neonatal and maternal outcome. Material and methods: Perinatal data records from 3075 mothers and 3158 children were evaluated before (period A) and after (period C) introduction of spinal anesthesia. To combine maternal and neonatal data a macro was programmed in Microsoft® Excel 2000. In order to describe the distribution of different anesthesia procedures, an anesthesia index (AI) was introduced: AI = 2 x percentage of general anesthesia + 1 x percentage of epidural anesthesia + 1 x percentage of spinal anesthesia. Results: The anesthesia index decreased significantly with all cesarean sections from 1,57 to 1,37 (p=0,000), with primary cesarean sections from 1,49 to 1,32 (p=0,000) and with secondary cesarean sections from 1,64 to 1,42 (p=0,000). In period A as well as in period C there is a significant correlation between the indication for cesarean section and the selection of anesthesia procedure (p=0,006; p=0,000). Neonatal Apgar-scores and pH-values depend significantly on the anesthesia procedure, but however do not differ between period A and C. The frequency of maternal complications is independent of the assigned anesthesia procedure and does not differ between period A and period C. Conclusion: These results underline the advantages of regional procedures for anesthesia in cesarean section.