Anaesthesia for caesarean section
and postpartum cardiovascular events in congenital heart disease: a
retrospective cohort study
A Tsukinaga,a K Yoshitani,a Y
Kubota,a E Kanemaru,a K
Nishimura,b M Nakai,c S
Ogata,b R Tsukinaga,d CA
Kamiya,d J Yoshimatsu,d Y
Ohnishia
a Department of Anaesthesiology, National Cerebral and
Cardiovascular Centre, Suita, Osaka, Japan
b Department of Preventive Medicine and Epidemiology,
National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
c Department of Statistical Analysis, National
Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
d Department of Obstetrics and Gynaecology, National
Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
Corresponding Author:
Kenji YOSHITANI, MD
Department of Anaesthesiology, Department of Transfusion, National
Cerebral and Cardiovascular Centre,
6-1 Kishibe-shinmachi, Suita, Osaka, Japan
TEL: +81-6-6170-1070
E-mail: ykenji@ncvc.go.jp
Running head: Anaesthesia for caesarean section in CHD
Abstract
Objective To clarify the association between anaesthetic
technique and maternal and neonatal outcomes in parturients with CHD.
Design Retrospective observational cohort study.
Setting Academic hospital.
Population A total of 263 consecutive parturients with
congenital heart disease (CHD) who underwent caesarean section.
Methods Charts from 1994–2019 were reviewed.
Main outcome measures We compared postpartum cardiovascular
events (composite of heart failure, pulmonary hypertension, arrhythmia,
and thromboembolic complications) and neonatal outcomes (intubation and
Apgar score <7 at 1 or 5 minutes) by anaesthetic technique.
Results Among 263 caesarean sections, general anaesthesia was
performed in 47 (17.9%) parturients and neuraxial anaesthesia in 214
(81.3%) parturients. Cardiovascular events were more common in the
general anaesthesia group (n=7; 14.9%) than in the neuraxial
anaesthesia group (n=17; 7.9%). Generalized linear mixed models
assuming a binomial distribution (i.e., mixed-effects logistic
regression) with a random intercept for each modified World Health
Organization classification for maternal cardiovascular risk revealed
that general anaesthesia is not significantly associated with
cardiovascular events (odds ratio [OR], 1.00; 95% confidence
interval [CI], 0.30–3.29). In addition, general anaesthesia was
associated with composite neonatal outcomes (Apgar score <7 at
1 or 5 minutes or need for neonatal intubation; OR, 13.3; 95% CI,
5.52–32.0).
Conclusion Anaesthetic technique is not significantly
associated with postpartum composite cardiovascular events. General
anaesthesia is significantly associated with increased need for neonatal
intubation and lower Apgar scores.
Funding No external funding was used in the conduct of this
study.
Keywords Anaesthesia, caesarean section, postpartum,
cardiovascular events, congenital heart disease, neonatal outcomes
Tweetable abstract Anaesthetic technique for caesarean section
is not significantly associated with cardiovascular events in patients
with CHD.