Critical Appraisal : Effect of Spinal and

General Anaesthesia Over APGAR Score in

Neonates Born After Elective Cesarean Section

Pembimbing: dr.Yuki Yunanda M.kes

Dicky
090100265
Duas Jourgie Simatupang 090100274
Astrie Hananda Febriancy 090100299

Abstract
Objective: To compare the effects of general
anaesthesia and spinal anaesthesia on
APGAR SCORES in neonates born to full term
elective cesarean sections.
Design: Randomized prospective study.
Place and Duration of Study: The study was
carried out at Abbasi Shaheed Hospital from
March 2009 to July 2009.

Abstract
MATERIAL AND METHODS: The study was
performed on 60 healthy full term patients
lying
in
American
Society
of
Anaesthesiologist category presenting for
elective lower segment cesarean section.
Thirty patients were given general
anaesthesia and other 30 patients received
spinal anaesthesia. The Apgar scores were
recorded at 1 minute and 5 minutes interval
after each delivery.

Abstract
RESULTS: Patients undergoing general
anesthesia, who had short time interval
between induct of anaesthesia and delivery ,
gave birth to neonates having APGAR Score
7 at 5 minutes interval and there was less
difference in the effects of general and spinal
anaesthesia on the Apgar Score of such
neonates.

Abstract
CONCLUSION : There was no significant
difference between the effects of general
anaesthesia and spinal anaesthesia on Apgar
score of neonates at 5 minutes interval after
birth, born after full term elective cesarean
section.

Valid
Are The Results Valid
1 Was the assignment of patients to treatments
randomized? And was the randomization list
concealed?

1.A. Yes, 60 healthy patients were split into 2 groups.

30 patients were given general anesthesia and
30 others were given spinal anesthesia.
Randomization was done restrictively so
equilibrium can be reached.
1.B. In this study, single or double blind method are
not mentioned.

2 Was follow-up of patients sufficiently long and

complete?

No, the follow up of patients was only conducted for 5

minutes after cesarean delivery. But all of patients are
completely followed up.

3 Were patients analyzed in the groups

to which they were randomized?

Yes, every subject are analyzed in their own group

according to randomization. 30 subjects in general
anesthesia group, and 30 others in spinal anesthesia
group.

4 Were patients, health workers,

and study personnel "blind" to treatment?

In this study, it is not mentioned if patients and

clinicians were kept blind to treatment.

5 Were the groups treated equally, apart from the

experimental treatment?

Yes, although the anesthetic method are different to

each group, but every subject are treated equally with
elective cesarean section.

6 Were the groups similar at the start

of the trial?

Yes, each group are the same since the beginning of

study.

Important

What is the magnitude of the treatment

effect?

General anesthesia
Min 1
APGAR
7

APGAR
6

GA

25

SA

20

TOTAL

25

TOTAL

Min 5

TOTAL

APGAR
7

APGAR
6

30

29

30

10

30

30

30

35

60

59

60

 Menit ke-1

Menit ke-5

Spinal Anesthesia
Min 1
APGAR
7

APGAR
6

SA

20

10

GA

TOTAL

25

TOTAL

Min 5

TOTAL

APGAR
7

APGAR
6

30

30

30

25

30

29

30

35

60

59

60

 Menit ke-1

Menit ke-5

Important
2. How precise is this estimate of the treatment
effect?
It is not mentioned in this study about the
confidence interval of the treatment effect.

Applicable
Are these valid, important results applicable to
our patient?
1 Is our patient so different from those
in the study that its results cannot apply?

No, our patient has the same

characteristics as the patients from the
study.

2 Is the treatment feasible in our setting?

Yes, while considering effectivity and

side effects of treatment.

3 What are our patients potential benefits and

harms from the therapy?

The benefit from the therapy is spinal

anesthesia is safer than general
anesthesia. The harm is APGAR Score in
babies from patients with general
anesthesia are lower than ones in spinal
anesthesia.

4 What are our patients values and

expectations for both the outcome we are
trying to prevent and the treatment we are
offering?

Yes, patients values and expectations

are the spinal anesthesia are better
than general anesthesia for the
outcome which is the APGAR Score from
the babies.

Thank You