COMPARISON OF GENERAL AND EPIDURAL ANESTHESIA FOR CESAREAN DELIVERY IN HEART DISEASE COMPLICATING PREGNANCIES – A RANDOMIZED PROSPECTIVE STUDY

Abstract

Background: Significant cardiovascular system hemodynamic alterations during pregnancy have been linked to increased morbidity and mortality in women with underlying heart disease.

 Objective: Study to compare hemodynamic changes and complications in General and Epidural anesthesia for cesarean delivery in Heart disease complicating pregnancy.

Methods: A total of 100 patients were randomly allocated into two groups. After approval by ethical committee, informed consent to be obtained. Information to be collected including age, gestational age, parity, cardiovascular disease. Baseline physical examination, Basic investigations to be done. The patients undergoing general anaesthesia are premedicated with i.v. glycopyrrolate (0.2 mg). Preoxygenation with 100% oxygen for 3 min. Patient induced with inj.Thiopentone 3-5mg/kg, Intubated with appropriate size ET tube after Inj. Succinylcholine 1.5mg/kg IV. After delivery, anaesthesia maintained with oxygen in nitrous oxide (33:66), with the addition of i.v. fentanyl. Relaxation to be maintained with inj. Atracurium 0.5mg/kg. The patients undergoing epidural anaesthesia, 18 G Tuohy needle inserted into L2-L3 space, Test dose of 3ml 1.5% lidocaine and 1:2,00000 epinephrine to be injected into the catheter, when patients shown no ill effects, 10ml of 1.5% lignocaine to be injected. Hemodynamic changes and complications to be noted.

Results: cardiovascular events decreased in epidural group. Complications occurred in general anesthesia, not in epidural group.

Conclusion: Epidural anesthesia is better than general anesthesia in maintaining hemodynamics & less complication.