Comparative Evaluation Of Perioperative Complications In General Versus Spinal Anaesthesia For Cesarean Delivery: A Prospective Observational Study

Abstract

Background: Cesarean section (C-section) is one of the most frequently performed surgical procedures globally. The choice between Spinal Anaesthesia (SA) and General Anaesthesia (GA) is governed by clinical urgency, maternal anatomical considerations, and systemic stability. While SA is widely recognised as the gold standard for elective procedures, GA remains vital in emergency or high-risk scenarios. This study aims to prospectively evaluate and compare the nature, frequency, and severity of anaesthetic complications associated with General versus Spinal Anaesthesia in parturients undergoing C-section.

Methods: A prospective observational study was conducted among N = 60 parturients aged 25 to 40 years with American Society of Anesthesiologists (ASA) physical status II or III who underwent elective or emergency C-sections at SGT Medical College, Hospital, and Research Institute, Gurugram. Participants were divided into two equal cohorts (n = 30 each) receiving either General Anaesthesia (Group A) or Spinal Anaesthesia (Group B). Physiological parameters (Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP], Pulse Rate [PR]), demographic data, and intraoperative/postoperative complications were documented and analysed using independent t-tests and Chi-square tests.

Results: Parturients in the SA cohort experienced a significantly higher incidence of maternal hypotension (60.0%, n = 18; p < 0.001) and intraoperative shivering (60.0%, n = 18) than in the GA cohort. The SA group demonstrated significantly lower post-induction SBP (112.80 ± 11.08 mmHg vs. 126.72 ± 6.14 mmHg, t = 5.94, p = 0.001) and PR (71.93 ± 7.30 bpm vs. 77.17 ± 7.95 bpm, t = 2.64, p = 0.011). Conversely, the GA cohort exhibited major airway-related challenges, with difficult intubation reported in 40.0% (n = 12) and failed intubation in 30.0% (n = 9) of cases. Postoperative hypothermia occurred in 23.0% of GA cases, whereas post-procedural pain (23.0%) and nausea/vomiting (20.0%) were predominantly observed in SA cases.

Conclusion: Both anaesthetic modalities possess distinct risk profiles. Spinal Anaesthesia provides superior airway safety and post-procedural comfort but carries a high burden of sympathetically mediated hypotension and hypothermic shivering. General Anaesthesia avoids sympatholysis-induced hemodynamic drops but introduces substantial risks of airway failure. Meticulous preoperative planning, rigorous airway screening, and proactive vasopressor/thermal management are vital to optimising maternal outcomes.