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Volume 13, Issue 1 (1-2025)
J. Pediatr. Rev 2025, 13(1): 29-40 |
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Pahnabi A, Montazami M, Daneshian M. APGAR Scores in Cesarean Deliveries: Effects of General and Spinal Anesthesia: A Systematic Review. J. Pediatr. Rev 2025; 13 (1) :29-40
URL: http://jpr.mazums.ac.ir/article-1-596-en.html
URL: http://jpr.mazums.ac.ir/article-1-596-en.html
1- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
2- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
3- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. ,mdaneshian80@gmail.com
2- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
3- Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. ,
Abstract: (459 Views)
Background: General and spinal anesthesia (SA) are widely used in cesarean deliveries. General anesthesia (GA), favored for emergencies, provides rapid onset but raises concerns about neonatal outcomes due to transplacental drug transfer. SA, preferred for elective procedures, allows maternal consciousness, enhancing neonatal outcomes and minimizing systemic effects.
Objectives: We conducted this review to compare the effects of general and SA on neonatal appearance, pulse, grimace response, activity, and respiration (APGAR) scores in cesarean deliveries and evaluate associated maternal and neonatal outcomes.
Methods: A systematic review of studies published between January 2000 and September 2023 was conducted. Databases searched included PubMed, Embase, and Cochrane Library. The inclusion criteria encompassed English-language studies on general or spinal anesthesia during cesarean deliveries and their effects on APGAR scores.
Results: We reviewed several studies, encompassing findings from diverse investigations. The cumulative insights shed light on the comparative effects of general and SA, with additional considerations for newborn rectal temperature, regional cerebral oxygenation, and cases of placenta previa. Some studies compared APGAR scores between general and SA groups in elective cesarean deliveries. Contrary to concerns about prolonged anesthesia duration, the study found no significant difference in mean APGAR scores. Additionally, another investigation observed comparable APGAR scores and cord blood gas values between GA and combined spinal-epidural anesthesia (EA), highlighting the efficiency of GA. Another study reported superior APGAR and neurologic scores, favorable blood gas values, and earlier breastfeeding initiation with SA. Nevertheless, another study found no significant impact on short-term outcomes with different anesthesia methods, reinforcing the safety of both approaches. Studies examining newborn rectal temperature revealed lower temperatures in the spinal group. This observation, coupled with slightly lower APGAR scores and umbilical vein pH, suggests a mild risk of temperature reduction without reaching critical hypothermia. Other studies demonstrate the superiority of combined spinal-EA over GA in regional cerebral oxygenation. This outcome emphasizes potential benefits for neonatal well-being, aligning with the broader discussion on the advantages of neuraxial anesthesia. Some studies specifically focused on placenta previa cases. The findings highlighted the advantages of neuraxial anesthesia over GA, showcasing improved maternal outcomes and a lower rate of neonatal asphyxia in the context of placenta previa. Heterogeneity in study designs and populations may limit generalizability. Additional randomized controlled trials are recommended.
Conclusions: Both methods are safe, with SA offering neonatal advantages in elective cases and GA being effective in emergencies. Further research is needed to refine guidelines.
Objectives: We conducted this review to compare the effects of general and SA on neonatal appearance, pulse, grimace response, activity, and respiration (APGAR) scores in cesarean deliveries and evaluate associated maternal and neonatal outcomes.
Methods: A systematic review of studies published between January 2000 and September 2023 was conducted. Databases searched included PubMed, Embase, and Cochrane Library. The inclusion criteria encompassed English-language studies on general or spinal anesthesia during cesarean deliveries and their effects on APGAR scores.
Results: We reviewed several studies, encompassing findings from diverse investigations. The cumulative insights shed light on the comparative effects of general and SA, with additional considerations for newborn rectal temperature, regional cerebral oxygenation, and cases of placenta previa. Some studies compared APGAR scores between general and SA groups in elective cesarean deliveries. Contrary to concerns about prolonged anesthesia duration, the study found no significant difference in mean APGAR scores. Additionally, another investigation observed comparable APGAR scores and cord blood gas values between GA and combined spinal-epidural anesthesia (EA), highlighting the efficiency of GA. Another study reported superior APGAR and neurologic scores, favorable blood gas values, and earlier breastfeeding initiation with SA. Nevertheless, another study found no significant impact on short-term outcomes with different anesthesia methods, reinforcing the safety of both approaches. Studies examining newborn rectal temperature revealed lower temperatures in the spinal group. This observation, coupled with slightly lower APGAR scores and umbilical vein pH, suggests a mild risk of temperature reduction without reaching critical hypothermia. Other studies demonstrate the superiority of combined spinal-EA over GA in regional cerebral oxygenation. This outcome emphasizes potential benefits for neonatal well-being, aligning with the broader discussion on the advantages of neuraxial anesthesia. Some studies specifically focused on placenta previa cases. The findings highlighted the advantages of neuraxial anesthesia over GA, showcasing improved maternal outcomes and a lower rate of neonatal asphyxia in the context of placenta previa. Heterogeneity in study designs and populations may limit generalizability. Additional randomized controlled trials are recommended.
Conclusions: Both methods are safe, with SA offering neonatal advantages in elective cases and GA being effective in emergencies. Further research is needed to refine guidelines.
Keywords: Cesarean deliveries, Anesthesia impact, Appearance, pulse, grimace, activity, and respiration (APGAR) scores, Spinal anesthesia (SA), General anesthesia (GA)
Type of Study: Review Article |
Subject:
Anesthesiology
Received: 2024/01/13 | Accepted: 2025/02/1 | Published: 2025/01/21
Received: 2024/01/13 | Accepted: 2025/02/1 | Published: 2025/01/21
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