Stress response associated with elective cesarean delivery: A comparison of the effect of general versus subarachnoid anesthesia

Abstract

Context: Pregnancy, surgery, and anesthesia are identified forms of stress to the body. Sustained response to stress has been associated with increased morbidity and mortality. Aim: The aim of the study is to determine the effect of anesthetic techniques on the response to the stress of surgery and anesthesia. Study Design: This was a prospective, randomized, double-blind study. Subjects and Methods: One hundred and forty patients scheduled for elective cesarean section were recruited and randomized into two groups: general anesthesia and subarachnoid anesthesia. Heart rate (HR), blood glucose, and cortisol levels were used to evaluate the body response to stress. Blood samples to estimate glucose and cortisol levels were taken the night of the day before surgery, just before induction, 30 min after induction, 60 min after induction, and 24-h postsurgery. The Statistical Package for the Social Sciences Version 23 was used for analysis to find the mean and standard deviation of both categorical and noncategorical variables. The Independent t-test and two-tailed test were used to show the differences in the HR, blood glucose, and cortisol levels within and between the general anesthesia and subarachnoid anesthesia groups. Results: The two groups were comparable in terms of age, height, weight, and American Society of Anesthesiologists status. The changes in HR and blood glucose were similar in both groups. However, a statistically significant difference was noted in the level of cortisol between the two groups at 60-min postskin incision with 494 ± 161 nmol/L in the general anesthesia group as opposed to 347 ± 161 nmol/L in the subarachnoid anesthesia group with a P = 0.01. Conclusions: The study demonstrated that subarachnoid anesthesia offers an advantage over general anesthesia in terms of the reduction to stress response to surgery and anesthesia. However, patient's choice and the urgency in the delivery of the fetus should be considered in choosing a mode of anesthesia.