Differential impacts of modes of anaesthesia on the risk of stroke among preeclamptic women who undergo Caesarean delivery: A population-based study

Abstract

Background. This study compared the stroke-free survival rates and hazard ratios (HRs) for stroke between preeclamptic women who received general anaesthesia and those who received neuraxial anaesthesia for Caesarean section (CS). Methods. This study used 2002-7 data from the Taiwan National Health Insurance Research Database. The stroke-free survival rate was estimated by the Kaplan-Meier method. The log-rank test was used to examine the difference in the stroke-free survival rates between general, spinal, and epidural anaesthesia. The Cox proportional hazard regression was used to estimate the HR for general anaesthesia. Results. A total of 303 862 women underwent CS of which 8567 had preeclampsia (75 stroke cases) and 295 295 did not (303 stroke cases). The stroke-free survival rate was significantly lower in the preeclamptic women who received general anaesthesia when compared with those who received epidural (P=0.008) or spinal anaesthesia (P<0.001) within the 6 yr period after the index delivery. There was no statistically significant difference between spinal and epidural anaesthesia in terms of stroke rate (P=0.143). The unadjusted HR of stroke for general anaesthesia was 2.81 [95 confidence interval (CI), 1.69-4.64; P<0.001]. After adjusting for potential confounders, the adjusted HR for general anaesthesia was 2.38 (95 CI, 1.33-4.28; P=0.004) compared with neuraxial anaesthesia over a 1-6 yr follow-up period. Conclusions. In this study, general anaesthesia for CS delivery was associated with increased risk of stroke when compared with neuraxial anaesthesia in preeclamptic women. © The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.