Effects of different anesthetic techniques on neurologic and adaptation capacity in newborn with elective cesarean section


1 Department of Anesthesiology and Critical Care, Al-Zahra Medical Center, Isfahan, Iran

2 Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Neurologic and Adaptive Capacity Scoring (NACS) has been introduced as a screening test for diagnosis of central nervous system depression due to intrapartum drugs on the neonate. This test can show neurological and behavioral changes even in the presence of a normal Apgar score. NACS has 20 indicators, each indicator allocating to itself the score zero, one or two. The aim of this study was to compare the effects of different anesthetic techniques on the NACS values.
Materials and Methods: This study was performed as a randomized, single-blind clinical trial on 75 infants born with elective cesarean in Shahid Beheshti Hospital, Isfahan. Simple Sampling method was carried out and the information was gathered by questionnaires. Anesthetic techniques included general, spinal or epidural anesthesia. NACS score was assessed at 15th min, 2 and 24 h after birth and then the anesthesia technique was recorded in the questionnaire. NACS score 35 or above was considered normal and 34 or less was abnormal.
Results: In the present study, no significant correlation was found between the anesthesia techniques and NACS score. The mean NACS at 15 min after birthin the general, spinal and epidural groups were 33.5 ± 2.2, 33.0 ± 4.4 and 33.7 ± 1.6 respectively (P = 0.703).
Conclusion: All three anesthetic techniques have identical effects on neurological and compatibility capacity of neonates born with elective cesarean; so, this could necessarily be a base to recommend the three methods equally.


Amiel-Tison C, Barrier G, Shnider SM, Levinson G, Hughes SC, Stefani SJ. A new neurologic and adaptive capacity scoring system for evaluating obstetric medications in full-term newborns. Anesthesiology 1982;56:340-50.  Back to cited text no. 1
Hodgkinson R, Bhatt M, Kim SS, Grewal G, Marx GF. Neonatal neurobehavioral tests following cesarean section under general and spinal anesthesia. Am J Obstet Gynecol 1978;132:670-4.  Back to cited text no. 2
Abboud TK, Nagappala S, Murakawa K, David S, Haroutunian S, Zakarian M, et al. Comparison of the effects of general and regional anesthesia for cesarean section on neonatal neurologic and adaptive capacity scores. Anesth Analg 1985;64:996-1000.  Back to cited text no. 3
Backe SK, Kocarev M, Wilson RC, Lyons G. Effect of maternal facial oxygen on neonatal behavioural scores during elective Caesarean section with spinal anaesthesia. Eur J Anaesthesiol 2007;24:66-70.  Back to cited text no. 4
Suzuki K, Nakai K, Hosokawa T, Oka T, Okamura K, Sakai T, et al. Association of maternal smoking during pregnancy and infant neurobehavioral status. Psychol Rep 2006;99:97-106.  Back to cited text no. 5
Morrow CE, Bandstra ES, Anthony JC, Ofir AY, Xue L, Reyes ML. Influence of prenatal cocaine exposure on full-term infant neurobehavioral functioning. Neurotoxicol Teratol 2001;23:533-44.  Back to cited text no. 6
Salisbury AL, Lester BM, Seifer R, Lagasse L, Bauer CR, Shankaran S, et al. Prenatal cocaine use and maternal depression: Effects on infant neurobehavior. Neurotoxicol Teratol 2009;31:69.  Back to cited text no. 7
Dick WF. Anaesthesia for caesarean section (epidural and general): Effects on the neonate. Eur J Obstet Gynecol Reprod Biol 1995;59 Suppl:S61-7.  Back to cited text no. 8
Abboud TK, Kim KC, Noueihed R, Kuhnert BR, DerMardirossian N, Moumdjian J, et al. Epidural bupivacaine, chloroprocaine, or lidocaine for cesarean section – Maternal and neonatal effects. Anesth Analg 1983;62:914-9.  Back to cited text no. 9
McGuinness GA, Merkow AJ, Kennedy RL, Erenberg A. Epidural anesthesia with bupivacaine for Cesarean section: Neonatal blood levels and neurobehavioral responses. Anesthesiology 1978;49:270-3.  Back to cited text no. 10
Aydin GB, Coskun F, Sahin A, Aypar U. Influence of sevoflurane and desflurane on neurological and adaptive capacity scores in newborns. Saudi Med J 2008;29:841-6.  Back to cited text no. 11
Sharifi M, Hashemi SJ, Jabalameli M. Associated neurologic and adaptive capacity scoring system in infants born to mothers undergoing cesarean with maternal factors and fetal anesthesia. J Isfahan Med Sch 2011;1106-115  Back to cited text no. 12
Brown DL. Spinal, epidural, and caudal anesthesia. In: Miller RD, editors. Miller's Anesthesia. 7th ed., Ch. 51. Philadelphia: Saunders Co.; 2010. p. 1620.  Back to cited text no. 13
Brockhurst NJ, Littleford JA, Halpern SH. The neurologic and adaptive capacity score: A systematic review of its use in obstetric anesthesia research. Anesthesiology 2000;92:237-46.  Back to cited text no. 14
Romano MA. On "neonatal neurobehavioral organization after exposure to maternal epidural analgesia in labor". J Obstet Gynecol Neonatal Nurs 2011;40:142.  Back to cited text no. 15