Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .
General anaesthesia versus epidural anaesthesia for primary caesarean section--a comparative study.
Forty-seven healthy parturients undergoing elective Caesarean section were r and omly allocated to either general anaesthesia  ( n = 24 ) or epidural anaesthesia  ( n = 23 ) under st and ardized anaesthetic and surgical conditions . Seven women of the epidural group required additional systemic analgesia or sedation following delivery of the neonate . Nine of 24 newborns obtained 1-min Apgar scores below 7 after general anaesthesia compared to only 3/23 after epidural anaesthesia . The time period to establish normal colour in the babies was 2.2 min after epidural and 4.9 min after general anaesthesia . Three of the 24 general-anaesthesia newborns demonstrated a tendency to hypotonia compared to only one in the epidural group . Twenty-four hours and 7 days after delivery all infants of both groups were completely normal . At the time of delivery maternal PO2 was higher in the general anaesthesia compared to the epidural group , due to higher inspired oxygen concentrations . Comparable results were obtained in umbilical PO2 venous values ; lower pH values , however , were observed in the umbilical artery after general anaesthesia . There were no significant differences in the glucose levels between the groups . A significant correlation was established between uterine incision-delivery interval and 1-min neonatal Apgar scores in the general-anaesthesia group , but not in the epidural group . Our investigation did not show either the incision-delivery interval or the start of operation-delivery interval to play a role in neonatal outcome . Epidural anaesthesia is superior to general anaesthesia in Caesarean section under normal conditions with regard to neonatal outcome . Whether this is also true for critical conditions can not be concluded from this study
Compared with general anaesthesia , a central neuraxial block may reduce the zero to 30-day mortality for patients undergoing surgery with intermediate to high cardiac risk ( level of evidence , moderate ) .
BACKGROUND Various beneficial effects derived from neuraxial blocks have been reported .
However , it is unclear whether these effects have an influence on perioperative mortality and major pulmonary/cardiovascular complications .
OBJECTIVES Our primary objective was to summarize Cochrane systematic review s that assess the effects of neuraxial blockade on perioperative rates of death , chest infection and myocardial infa rct ion by integrating the evidence from all such review s that have compared neuraxial blockade with or without general anaesthesia versus general anaesthesia alone for different types of surgery in various population s. Our secondary objective was to summarize the evidence on adverse effects ( an adverse event for which a causal relation between the intervention and the event is at least a reasonable possibility ) of neuraxial blockade .