Effects of General Anesthesia vs Regional Anesthesia on Neonatal Outcomes: A Systemic Review and Mata Analysis

Backgrounds: Types of anesthesia provision and perioperative patient cares are the main determinants of neonatal outcome in mothers undergo caesarean section. Body of evidence didn't clearly reveal which types of Anesthesia technique is associated with better neonatal outcomes in mothers who gave birth under spinal anesthesia than general anesthesia. The aim of this systemic review and meta-analysis was to compare neonatal outcomes in mothers who undergo caesarean section under general anesthesia and regional anesthesia. Methods: We carried out a systemic search of the electronic databases of central, Medline, Embase, LILACS, AOLJ and others with PICO strategy for controlled clinical trials comparing neonatal outcomes under general and regional anesthesia. Twenty trials were identified for eligibility assessment, ten trials were selected for data extraction, and nine trials were finally included in the meta-analysis. All controlled clinical trials using regional and general anesthesia for ASA I-II term pregnant women coming for cesarean section in elective and semi-urgent condition were selected. Eligibility assessment was performed independently by the two review authors using a customized form, while discrepancies were resolved by consensus. The Data from individual trial were extracted and entered Review Manager for synthesis. Results: Ten studies (782 participants) were included in this review. The Apgar score at one minute less than seven was better in spinal anesthesia as compared to General Anesthesia (OR=0.24, 95% confidence interval (CI) 0.14 to 0.42, 5 trials, 548 participants). There was no significant association at 5th minute Apgar score less than seven (OR= -0.02, 95% CI -0.09 to 0.05, 3 trials, 260 participants). There was significant mean difference between spinal and general anesthesia on neonatal mean Apgar score at 5th minute (MD=0.51, 95% CI 0.14 to 0.88, 5 trials, 671 participants). There was a significant mean difference on Umbilical artery and Venous PH when general anesthesia is compared with spinal anesthesia (MD= -0.01, 95% CI -0.002 top -0.00, one trial, 40 participants) and (MD= -0.98, 95% CI -1.66 to -0.30, one trial, 40 participants). Conclusion: Regional Anesthesia is superior over general Anesthesia in certain neonatal outcomes as depicted by the pooled analysis of individual trials. However, there should be further review with individual trials having high power and similar dosage and techniques as most of the individual trials in this review are low powered and different types of outcome assessment techniques.