Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis.
Int J Obstet Anesth
; 37: 5-15, 2019 Feb.
Article
em En
| MEDLINE
| ID: mdl-30415797
ABSTRACT
BACKGROUND:
This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery.METHODS:
An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included Apgar score at 1- or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2-4â¯hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and τ2. Quality of evidence was assessed using the GRADE approach.RESULTS:
Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score ≤6 at 1â¯min between spinal versus general anesthesia (odds ratio 0.27, 95% confidence interval [CI] 0.13 to 0.55 moderate quality evidence) and Apgar scores at 1- and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95% CI 0.001 to 0.020 moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score ≤6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3).CONCLUSIONS:
Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cesárea
/
Metanálise em Rede
/
Anestesia Epidural
/
Anestesia Geral
/
Anestesia Obstétrica
/
Raquianestesia
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Limite:
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Int J Obstet Anesth
Assunto da revista:
ANESTESIOLOGIA
/
OBSTETRICIA
Ano de publicação:
2019
Tipo de documento:
Article