The assessment of optimal anesthesia technique for cesarian section and its clinical effects on mother and newborns.

INTERVENTION: Seventy‐five ASA II parturients who did not have endocrine, cardiopulmonary, renal, hepatic or neuromuscular diseases, and undergo cesarean section for their first delivery, and in their 38th week of the pregnancy, without preeclampsia or fetal problems (fetal abnormalities, growth retardation, umbilical artery anomalies, malposition) were included. Patients were randomly divided into three groups (n=25): general anesthesia, epidural anesthesia and spinal anesthesia. The randomization was performed using sequentially numbered, opaque sealed envelopes. In General anesthesia group, patients received 5 mg/kg thiopental sodium and 0.6 mg/kg rocuronium bromide intravenous for induction of anesthesia. After the patients were intubated, anesthesia was maintained with 30% O2, 70% N2O and 1‐2% sevoflurane. Mechanical ventilation was performed by setting the tidal volume at 6‐8 mL/kg and the respiratory rate at 8‐10/minute. Patients were ventilated with 100% O2 during the period between placement of bladder retractor and cord clamping after delivery. Neuromuscular block was antagonized with 0.03‐0.07 mg/kg neostigmine and 0.02 mg/kg atropine sulfate intravenous. Patients in Epidural anesthesia group were administered 16 mL of 0.5% bupivacaine + 3 mg morphine in lateral position through the L4‐L5 intervertebral space using an 18 G Touhy needle by the loss of resistance technique. An epidural catheter was left 5 cm in the epidural space. In Spinal anesthesia group, 3 mL of 0.5% bupivacaine with 200 µg morphine through the L4‐L5 intervertebral space by a 25 G spinal needle (Quincke) in lateral decubitus position. In Group Epidural anesthesia and Spinal anesthesia, surgery was started by the time the sensory block reached the T4 dermatome. The level of sensory block was assessed by the ‘Pinprick’ test. Motor block was assessed using the Bromage Scale. Mean arterial pressure, heart rate and SpO2 values were recorded before and after anesthesia induction, and at the 1s CONDITION: Anaesthesiology ‐ Other anaesthesiology Oral and Gastrointestinal ‐ Normal oral and gastrointestinal development and function Reproductive Health and Childbirth ‐ Breast feeding Reproductive Health and Childbirth ‐ Complications of newborn spinal anesthesia;epidural anesthesia;general anesthesia; ; spinal anesthesia ; epidural anesthesia ; general anesthesia PRIMARY OUTCOME: Blood gas analysis obtained from umblical veIn was examined at birth for becoming fetal acidosis [Blood gas analysis obtained from umblical ven was examined at birth in the operating room] The need for respiratory support in newborns. The need for respiratory support is assess as following; the need at birth for free O2, positive‐pressure ventilation (PPV), chest compressions, intubation and intensive care admission were obtained from the hospital records.[24 hours after surgery] The study was to evaluate the effect of the anesthesia technique on the APGAR score, The APGAR score is calculated by the pediatrician who has attended in labor at the time points 1, 5 and 10 minutes after birth as described in the literature.[1st, 5th and 10th minute from birth] INCLUSION CRITERIA: American Society of Anesthesiologists (ASA) II parturients first delivery 38th week of the pregnancy, SECONDARY OUTCOME: hospital discharge:time to discharge of mother obtained from hospital records[time to discharge of mother obtained from hospital records] level of bilirubin: biochemical test results for levels of bilirubin from blood sample of patient's.[first 48 hours after birth] Crystalloid requirement: Total amount of intravenous crystalloid given to the mother during the surgery. The requirement of crystalloid was recorded by anesthesiologist.[during the surgery] ephedrine requirement: when the mean arterial pressure showed a decrease of more than 30%, it was regarded as hypotension and ephedrine 10 mg was injected iv as a bolus dose., total dose of ephedrine requirement during the surgery.The need for ephedrine was recorded by anesthesiologist.[during the surgery] phototherapy requirement: decision was given by the pediatrician according to the bilirubin levels of the newborn, bilirubin levels were recorded from hospital records.[first 48 hours after birth] the time to return of the bowel function meaning the first defecation time of the mother was obtained from the hospital records.[48 hours after surgery.] Time to first breastfeeding: is the time from labor to first breastfeeding of the newborn. first breastfeeding was obtained from the hospital records.[the time from labor to first breastfeeding of the newborn. first breastfeeding was obtained from the hospital records.] weight loss of the newborns[weight loss of the newborn in the first 48 hours after delivery, the information is obtained from the hospital records]