Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections

Abstract

Background & Objective: There is an increased ratio of cesarean sections (CS) compared to normal deliveries the world over. Both general and regional anesthetic techniques are in practice for CS. Limited information is available on the determination of blood cholinesterase (ChE) activity in conjunction with oxidative stress biomarkers after the CS. The purpose of the present study was to determine and compare the plasma and erythrocyte ChE activity as well as malondialdehyde (MDA) level and total antioxidant status in pregnant women before anesthesia and after the use of general anesthesia (GA) or spinal anesthesia (SA) for elective CS.
 Methodology: A pre-post study was conducted on 102 full-term pregnant women, who underwent elective CS in four hospitals at Duhok (Iraq) from January 2022 to July 2022. GA with propofol and SA with bupivacaine 0.5% were administered to 52 and 50 women, respectively. Maternal blood samples before anesthesia and after the completion of operation were assayed for the ChE activity in the plasma and erythrocytes, and plasma oxidative stress biomarkers malondialdehyde and total antioxidant status.
 Results: Plasma ChE activity significantly decreased in the GA and SA groups after the cesarean-deliveries compared to the corresponding pre-anesthetic values. The plasma MDA level in both GA and SA groups, but not the total antioxidant status, was significantly reduced. Estimation of the odds ratio and the relative risk indicated that a risk factor is associated with the reduced plasma ChE activity in women after the CS when the general anesthetic propofol is used.
 Conclusion: Both general anesthesia with propofol and spinal anesthesia with bupivacaine inhibited plasma cholinesterase activity and reduced oxidative stress biomarker malondialdehyde after the cesarean sections.
 Abbreviations: CS - Cesarean section; ChE: Cholinesterase; EChE: Erythrocyte Cholinesterase; MDA: Malondialdehyde; OS: Oxidative Stress; PChE: Plasma ChE; TAS: Total Antioxidant Status.
 Key words: Anesthesia, Spinal; Cesarean section; General anesthesia; Malondialdehyde; Oxidative stress
 Citation: Karam RS, Mohammad FK. Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections. Anaesth. pain intensive care 2023;27(3):396−404; DOI: 10.35975/apic.v27i3.2244
 Received: March 23, 2023; Reviewed: May 06, 2023; Accepted: May 09, 2023

Plasma Cholinesterase Activity in Patients With Rheumatoid Arthritis and Toxoplasmosis

“…Variations (usually 20% or more are significant) in ChE activity after drug or pesticide applications have been used to assess the risk of association of changes in ChE activity by odds and risk ratios [27,28]. Observed and expected cases of 20% increment in plasma ChE activity among RA patients were used to calculate odds and risk ratios by using PAST4.13.…”

“…To achieve data categorization, an increase of 20% in plasma ChE activity (from a healthy-control value of 0.83 Δ pH/20 minutes) was taken into consideration. Accordingly, a table of odds and risk ratios of RA groups was constructed [27,28].…”

In vitro Effects of Propofol and Bupivacaine on Pregnant Women’s Plasma Cholinesterase Activity and Malondialdehyde Level

“…Normal pregnancy is associated with various physiologic and hemodynamic changes, especially during the last month very close to the delivery (1, 2), which might affect the response to drugs or anesthetics (3,4). Decreased plasma cholinesterase (ChE) activity and increased oxidative stress (OS) biomarkers in the plasma malondialdehyde (MDA) have been reported in the last trimester of pregnancy (5)(6)(7). The decrease in plasma ChE activity might predispose pregnant women to the possibility of adverse drug reactions when neuromuscular blocking agents or anesthetics are used, especially in cesarean section (CS) delivery (8)(9)(10).…”

“…On the other hand, OS biomarkers were reported to increase in pregnancy and were observed to be involved in the pathogenesis of preeclampsia complications (13,14). The general anesthetic propofol and the spinal one bupivacaine are widely used in CS delivery (15,16) and might affect plasma ChE activity and oxidative status (7,(17)(18)(19). These anesthetics even affect the quality of life after the CS delivery (20,21).…”

“…A recent report implicates the possibility of the existence of health risks from reduced plasma ChE activity during propofol anesthesia and increased OS in women undergoing elective CS delivery (7). However, despite some in vivo findings on plasma ChE and MDA levels (5-7), limited information is available on the in vitro assessment of anesthetics on pregnant women's plasma.…”