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BJA Advance Access originally published online on November 16, 2008
British Journal of Anaesthesia 2009 102(1):90-96; doi:10.1093/bja/aen321
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Supplementary oxygen for emergency Caesarean section under regional anaesthesia{dagger},{ddagger}

K. S. Khaw1,*, C. C. Wang2, W. D. Ngan Kee1, W. H. Tam2, F. F. Ng1, L. A. H. Critchley1 and M. S. Rogers2

1 Department of Anaesthesia and Intensive Care
2 Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China

* Corresponding author. E-mail: kimkhaw{at}cuhk.edu.hk

Background: Controversy still exists if the administration of supplementary oxygen to patients having emergency Caesarean section (CS) under regional anaesthesia is beneficial or potentially harmful. Therefore, in a prospective double-blinded study, we randomized patients having emergency CS under regional anaesthesia to receive either air or 60% oxygen until delivery and compared the effects on fetal oxygenation and lipid-peroxidation in the mother and baby.

Methods: We recruited 131 women having emergency CS under regional anaesthesia. Either 21% (air group) or 60% oxygen (oxygen group) was administered using a Venturi-type facemask until delivery. We compared the oxygen exposure duration, umbilical arterial (UA) and venous (UV) blood gases and oxygen content, and plasma concentration of 8-isoprostane. Subanalysis was performed according to whether or not fetal compromise was considered present.

Results: Data from 125 patients were analysed. For the oxygen group vs the air group, there were greater values for UA PO2 [mean 2.2 (SD 0.5) vs 1.9 (0.6) kPa, P=0.01], UA O2 content [6.6 (2.5) vs 4.9 (2.8) ml dl–1, P=0.006], UV PO2 [3.8 (0.8) vs 3.2 (0.8) kPa, P<0.0001], and UV O2 content [12.9 (3.5) vs 10.4 (3.8) ml dl–1, P=0.001]. There was no difference between the groups in maternal, UA, or UV 8-isoprostane concentration. Apgar scores and UA pH were similar between the groups. Similar changes were observed regardless of whether fetal compromise was considered present (n=37) or not (n=88).

Conclusions: Breathing 60% oxygen during emergency CS under regional anaesthesia increased fetal oxygenation with no associated increase in lipid-peroxidation in the mother or fetus.

Keywords: anaesthetic techniques, regional; oxygen, therapy; partial pressure, oxygen; pregnancy; toxicity, fetal

{dagger} Presented as a poster discussion at the American Society of Anesthesiologists 2004 Annual Meeting, Las Vegas, Nevada, USA, October 23–27.

{ddagger} This article is accompanied by the Editorial.


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