Analysis of clinical series with the use of adjuvants to general anesthesia during elective caesarean section

Abstract

Background. Caesarean section remains one of the most common surgical interventions in the world. The main disadvantages of the general anesthesia in caesarean section are a high risk of awareness during the operation and a pronounced hemodynamic reaction to the surgical trauma in a patient. The most dangerous period of intervention in terms of these complications is the period before the birth of a child. This article analyzes our own clinical cases of the general anesthesia during elective caesarean section with the addition of adjuvants and compares anesthetic management with world practices. In all cases from our own clinical practice, total intravenous anesthesia with artificial lung ventilation was performed. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg) and clonidine (100 μg), 30 minutes before the elective surgical intervention. The newborns were examined with the Apgar scale and umbilical venous blood gas analysis was carried out. Preoperative, intraoperative, and postoperative management of patients was based on recommendations of the Enhanced Recovery After Caesarean Section and guidelines of the PROSPECT working group. Results. The analysis of our own clinical cases revealed the presence of a hemodynamic reaction of the patient’s body to the operative injury (in the period before the birth of a child), which does not exceed safe levels; absence of anesthetic complications and cases of accidental awareness during surgery; absence of a negative influence of adjuvants on newborns; sufficient depth of anesthesia and reduction of the intraoperative doses of opioids and intravenous anesthetics (“on patient’s request”). Conclusions. The analysis of clinical cases argues for the need to use “safe adjuvants” (acetami­nophen, clonidine) to general anesthesia during elective caesarean section and the necessity for further research.