Maternal and neonatal effects of sevoflurane and desflurane in cesarean section

Abstract

Background: This study was designed to compare the maternal and neonatal effects of two volatile anesthetic agents, sevoflurane and desflurane during general anesthesia for cesarean section. Methods: Sixty patients undergoing cesarean section were randomly selected and divided into two groups. After induction, sevoflurane (Group S, n = 30) and desflurane (Group D, n = 30) were administered to achieve steady-state end-tidal concentration of 1 vol% and 3 vol%, respectively. The maternal outcomes were evaluated at various time points in terms of hemodynamic changes and bispectral index (BIS). The neonatal characteristics were descripted with Apgar score and umbilical blood gas analysis. Results: The BIS was lower in Group D than in Group S at 5 and 7 minutes after intubation and at delivery (P ＜ 0.05).The value of BIS is between 40 to 60 in Group D appropriated with anesthetic depth during surgery. Other parameters as well as neonatal outcomes were not different between two groups. Intraoperative awareness of patients were not present at all. Conclusions: Maternal and neonatal effects were not significantly different between two groups and no adverse effects were seen. Despite of BIS over 60 at some period, maternal recall during surgery were absent postoperatively. Therefore, not only sevoflurane but also desflurane can be used for safe and effective anesthesia in cesarean section.

Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure -A case report-

“…In contrast, fetal depression is not a consideration during the EXIT procedure. In fact, during the EXIT procedure, even intramuscular administration of drug cocktails and/or inhalational anesthetics (1-1.5 MAC) are recommended to ensure a motionless, well-anesthetized fetus [ 6 ]. Furthermore, there is no need to limit the time of anesthesia induction or the skin incision to delivery time.…”

“…First, deep inhalational anesthetics (1.5-3 MAC) are often used to relax the uterine muscles and to maintain the uteroplacental circulation [ 7 ]. Inhalational anesthetic concentrations of at least 2 MAC are usually recommended for proper relaxation of the uterine muscles and to prevent early placenta detachment [ 6 , 8 ]. For rapid onset and offset of tocolytic action during the EXIT procedure, sevoflurane or desflurane are recommended.…”