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.