Document Type : Review Article
Authors
1
Assistant Professor of Endocrinology & Metabolism, Department of Internal Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
2
Anesthesiology, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar AbbaS
3
Assistant Professor, Department of Anesthesiology, Anesthesiology & Critical Care and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4
Department of Anesthesiology, Intensive Care fellowship, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
5
Department of Anesthesiology, Tehran University of medical sciences, Tehran, Iran
6
Assistant Professor of Anesthesiology,Department of Anesthesiology and Critical Care, School of Medicine, 5th Azar Hospital, Sayyad Shirazi Hospital Golestan University of Medical Sciences
7
Associate Professor of Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
8
Assistant professor of ICU and critical care. Department of anesthesiology and critical care, Qom University of medical sciences, Qom, Iran.
10.22038/ijogi.2024.74605.5838
Abstract
Background: This systematic review and meta-analysis aimed to explore the impact of anesthesia type (general, spinal, epidural) on postoperative blood glucose levels in pregnant women with gestational diabetes.
Methods: A systematic review and meta-analysis were conducted by reviewing multiple relevant studies. We included studies that examined the influence of anesthesia types, such as general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia, on blood glucose levels, maternal stress response, opioid consumption, neonatal outcomes, and other relevant variables in pregnant women with GDM undergoing CS or normal delivery. Studies that met the inclusion criteria were selected, and their data were analyzed collectively.
Results: Our meta-analysis demonstrated significantly higher postoperative blood glucose levels associated with general anesthesia compared to spinal anesthesia (Random effect model; I2=99%). Publication bias was indicated by Egger's test and funnel plot; however, imputing missing studies using the Trim and Fill method yielded adjusted results that showed no statistical or clinical difference in blood glucose levels. GDM patients who underwent epidural analgesia were 73% less likely to experience the need for C-section (P<0.0001), with no heterogenicity between studies; while there were no differences in NICU admission of neonate and neonatal hypoglycemia. Quality of evidence extremely low in most studies.
Conclusion: our findings suggest no glycemic outcome differences between G and SA, while GDM patients who undergo epidural analgesia appear to have a reduced likelihood of requiring a C-section. These results emphasize the importance of anesthesia type selection and monitoring during surgery in specific clinical scenarios.
Keywords
Main Subjects
)