The use of anesthetics for cesarean section delivery in women in Duhok, Kurdistan region, Iraq

Abstract

Background: Limited information is available on anesthetics that are preferred or used by anesthesiologists for cesarean section (CS) delivery in Kurdistan region, Iraq. This study aims to document general or regional anesthesia use in elective CS deliveries in four major hospitals in Duhok province, Northern Iraq. Methods: A retrospective cross-sectional study was conducted from February 2019 to February 2020. The general and regional anesthetics types were recorded for each CS delivery case within the selected hospitals. Any adjuvants and medications used with the anesthetics were also recorded. Univariate and bivariate analyses were undertaken. The statistically significant was considered at less than 0.05. Results: A total of 3420 elective CS deliveries were reported. The mean age ± SD of the pregnant women was 29.6 ± 5.8 years. The anesthetics used in the four hospitals were propofol as a general anesthetic (53.0%) and bupivacaine as a spinal anesthetic (47.0%). The combination of propofol and bupivacaine was used only in 0.3%. The three most frequently and concurrently used adjuvants and medications with propofol or bupivacaine were metoclopramide (90.0%), dexamethasone (80.0%), and ephedrine (73.0%). Conclusion: Propofol and bupivacaine were the general and spinal anesthesia of choice, respectively, for elective CS delivery in Duhok province, northern Iraq. Some adjuvants and medications were supplemented to improve the quality of anesthesia and the outcome of CS delivery.

The Potential Risk of Reduced Serum Cholinesterase Activity in COVID-19 Patients Suffering From Cytokine Storm

“…The statistical analyses were performed using the software package Past4.15, which included descriptive statistics, odds and risk ratios, Student's t-test, or analysis of variance followed by Tukey's multiple comparison test. For the odds and risk ratio analyses [8,23,28], we considered that a decrease of 20% or more in serum ChE activity indicated a significant risk outcome in COVID-19-cytokine storm patients compared to their non-cytokine storm counterparts.…”

“…Considering the reduced serum ChE activity (≥20%) among COVID-19 patients with cytokine storm as a risk factor, we cannot, however, assume a direct causal association between reduced serum ChE activity and the clinical outcomes of COVID-19 or its severity. Nevertheless, reduced serum or plasma ChE activity is linked to acute inflammatory responses and systemic integrity, especially in immunocompromised patients [5][6][7][8][9]26,29]. Furthermore, a negative correlation of reduced serum ChE activity was observed in COVID-19 patients with inflammatory markers C-reactive protein and interleukin 6 [13] as well as with COVID-19induced pneumonia severity and mortality [14].…”

“…These two related enzymes are highly sensitive to ChE inhibitors such as organophosphate and carbamate insecticides [3] as well as to drugs used against Alzheimer's disease [2,4]. Plasma or serum ChE activity is used clinically to assess inflammatory responses involving the integrity of the cardiovascular and endocrine systems, as well as cholinergic anti-inflammatory pathways in maintaining the neuronal integrity and response to 1 2, 3 4 general anesthetics [5][6][7][8][9].…”

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

“…Current evidence strongly suggests an increasing preference of parturients for elective cesarean-delivery, apparently to avoid labor pains and the stress related to normal delivery, in many regions around the world, 1−3,32,33 including Iraq. 4,34 For elective CS, the most preferred GA is with propofol and SA with bupivacaine. The present study was conducted in four hospitals in Duhok, Iraq, to examine the effects of these two most commonly used anesthetics, on blood OS biomarker and ChE activity.…”

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

“…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).…”