Over half MAC sevoflurane in cesarean section
Department of Anesthesiology, Ramathibodi Hospital, the Faculty of Medicine, Mahidol University, Bangkok, Thailand.Journal of the Medical Association of Thailand = Chotmaihet thangphaet 08/2005; 88(7):914-20.
Half MAC (minimal alveolar concentration) of volatile anesthetics has been commonly used with nitrous oxide for cesarean section which could occur intraoperative awareness. Over half MAC or more than 1% sevoflurane was studied on 65 parturients who came for either elective or emergency operations. The patient characteristics were age 31.00+/-5.67(21-41) years, BW 72.37+/-10.51 (52.6-117) kg, and ASA physical status 1, 52% for elective and 73% for emergency cases. The indications for operations were mostly CPD, fetal distress and previous cesarean sections. The anesthetic time was 59.19+/-17.35 (35-145) minutes while the induction-delivery time was 12.72+/-5.66 (3-28) minutes. General anesthesia was rapid sequence induction with propofol or thiopental and tracheal intubation under succinylcholine with the application of cricoid pressure. The depth of anesthesia was maintained with 1.5-3% sevoflurane until delivery and the volatile agent was lowered to 0.4-1%, adjusted to clinical manifestation. Midazolam and morphine were added postdelivery. Data of hemodynamic changes during delivery, neonatal outcome and intraoperative blood loss were analyzed without any remarkable note. The postoperative interview on recalls confirmed adequate depth of anesthesia. It was concluded that sevoflurane at more than 1% concentration could be used predelivery in cesarean sections on the issues of awareness, hemodynamics and fetal conditions but caution was suggested in terms of uterine relaxation effect which was dose-dependent.
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ABSTRACT: To prevent awareness and uterine atony among parturients during general anesthesia for caesarean section, volatile anesthetic agents have been limited to 0.5 MAC in 50% N2O. This technique appeared to be inadequate to produce BIS values less than 60 in isoflurane and sevoflurane. To assess BIS value during general anesthesia with 3% and 4.5% desflurane in 50% N2O before delivery. The parturients were blinded and randomized in opaque envelopes to one of the two study groups. Seventy-two elective caesarean section ASA I - II parturients were induced and intubated with thiopental 4 mg/kg, succinylcholine 1.5 mg/kg and were received either 3% or 4.5% desflurane in 50% N2O to maintain general anesthesia. Both groups received rocuronium 0.6 mg/kg for muscle relaxation. Morphine 0.1 mg/kg and midazolam 0.06 mg/kg were administered after delivery. There were no differences in demographic data in both groups. The incidences of patients with a satisfactory BIS score (< 60) in the 4.5% desflurane group was 81% that was significantly more than 42% in the 3% desflurane group (p < 0.000). Mean BIS values at neonatal delivery were 62 +/- 8 in the 3% desflurane group, versus 49 +/- 12 in the 4.5% desflurane group. Indices of maternal and neonatal outcome were similar between the two groups. General anesthesia for caesarean section with 4.5% desflurane in 50% N2O maintained BIS < 60 more significantly than 3% of desflurane in 50% N2O without maternal and neonatal adverse effects in healthy paturients.