A major problem with general anesthesia for Cesarean section is the incidence of maternal awareness and unpleasant recall occasioned by the use small doses and low concentrations of anesthetics to minimize neonatal effect.
To reduce awareness, various measures have been attempted. The purpose of study is to assess the influence of ketamine, halothane and enflurane on the maternal awareness and neonatal depression under N2O for Cesarean section. This study group consisted of 48 patients undergoing Cesarean section under general anesthesia.
Anesthesia was induced by thiopental, succinylcholine chloride injected, and maintained until baby delivery with according to divided group.
Group 1: thiopental, 50% N20
Group 2: thiopental, 50% N2O and ketamine(0.25mg/kg)
Group 3: thiopental, 50% N2O and 0.5% halothane
Group 4: thiopental, 50% N20 and 0.6% enflurane
The results were as follows :
1. The incidence of awareness of 50% N2O group was 66.7%.
2. The incidence of awareness of ketamine, halothane and enflurane group was 8.3%.
3. When induction-delivery time is 8 minutes or less, there was no correlation between induction-delivery time and awareness.
4. There was no neonatal depression.
The use of ketamine, halothane and enflurane appears to be effective in preventing awareness when induction-delivery time is 8 minutes or less.
, Eun Chi Bang, Eun Ah Yang, Hyun Sook Lee, Yong In Kang, Kyung Sook Cho, Su Yeon Kim To compare the clnical data of general and regional anesthesia for cesarean section in patients with systemic hypertension.
We conducted a retrospective survey with the medical records of the patients with hypertensive disorders in pregnancy, who under went cesarean section from January 1998 to December 2012. We collected data including patients' demographics, anesthesia and maternal and neonatal outcome. According to anesthetic method, the subjects were divided into general anesthesia and regional anesthesia group and the clinical outcome were compared. We reclassified the patients according to the use of magnesium sul fate (MgSO4) and compared the clinical outcomes.
Of the 1,050 hypertensive parturients, 848 (80.8%) patients went through cesarean section. Three hundred and sixty three patients (42.8%) underwent epidural anesthesia, general and spinal anesthesia were used in 268 (31.6%), and 217 (25.6%) patients, respectively. There was no significant difference in maternal and neonatal outcome according to anesthetic method. In the patients administered MgSO4, 1 minute Apgar score was lower and maternal gestational age and birth weight were less than the patients not receiving MgSO4.
Anesthetic methods did not have effect on outcome of cesarean section of the patients with hypertensive disorder of pregnancy.
Citations
, Eun Chi Bang, Dong-Wook Shin, Dae Eun Kweon, Su Yeon Kim, Hyun Sook Lee, Kyung Sook Cho, Su Yeon Lee Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block.
Bupivacaine (0.5%) 9 mg with fentanyl 10 µg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine.
Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed.
Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
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