| ObjectiveWith the growth of the rate of the modern obstetric cesarean, the anesthesia quality should be primary concerned and more cared. Most of the pregnants are youth, so intense anxiety and stress response occurs during the anesthesia and operation. In this study, midazolam was injected intravenous before the epidural anesthesia, we observed the effect on the anxiety and stress response of mothers, and the adverse effect on the neonates. We tried to discuss the feasibility and the appropriate dosage.Method80 ASA physical status ? pregnants, having no histroy of operatation, aged 20 ~ 35 yr, weighted 60~75 kg of term delivery, single birth, scheduled for selective cesarean section under epidural anesthesia were randomized into four groups, each group of 20 examples: group M0, with saline 2ml I.V, control group; group M1, with 0.01mg/kg midazolam I.V; group M2, with 0.02mg/kg midazolam I.V; group M3, with 0.03mg/kg midazolam I.V. Not any other sedative were used. The patients who hadn't the mental disease, was in good health with the normal heart, lung, liver and kidney function and have not the diabetes, the fetal distress, the intrauterine growth retardation (IUGR), the abnormality of umbilial cord, the decrease of placenta function, and so on. After entering the operation room, with the anesthetic machine continuous monitoring BP, HR, SPO2, EKG, RR, the ringer's solution dropped. 5 min before the epidural anesthesia, the different dose of midazolam which had been diluted to 2ml injucted IV slowly. After the patients lying on the right, we performed an epidural anesthesia. 15 to 18ml 1.6%lidocaine to the epidural space in several times, the anesthesia level was controlled to T6.The bed was put on 15o left leaning position to prevent from supine hyportensive syndrome. No supplemental oxygen was administered to patients during the operation. Pulse oxygen saturation (SPO2), respiration rate (RR), mean arterial blood pressure (MAP), and heart rate (HR) before (T1) and after 5 min (T2), 15min(T3), 30min(T4) and after the administration of premeditation, were recorded. Before 5min (T1), after 30min (T4) the Anxiety Visual Analog Test (AVAT) was also recorded and 2ml venous blood were abstracted to determine the glucose and cortisol. .ResultMother's respiratory function: SPO2 and RR of four groups did not have obvious changes (P>0.05) except two patients of group M3 with full sedation and lower respiratory frequency after given the medicine.Mother's circulation function: After the medicine gaven , there was no big difference about MAP between T2 and T1; MAP at T3,T4 was lower (<30%) compared with that at T1 (P<0.05). HR of group M0, M1, M2 had no obvious change, but of group M3 had a drop(P<0.05), not less than 60 bpm. The AVAT scores of mothers ascended obviously in group M3 after administration (P<0.01). There was no obvious change in group M0, M1, M2(P>0.05).The concentration of plasma cortisol increased significantly in group M3 after administration, so did glucose (P<0.01). There was no significant difference in group M0, M1, M2 in either cortisol or glucose (P>0.05).The fetal Apgar scores at one and five minutes: There was no significant difference in four groups (P>0.05). The fetal oxygen saturation for three hours after birth: 2 of group M0 had a pulse oximetry reading less than 95%for more than ten seconds, and 3 of group M1; 2 of group M2; 2 of group M3. There was no significant difference in four groups (P>0.05). The NACS scores in another day have no statistic difference in four groups (P>0.05).ConclusionThe low dose midazolam (0.03mg/kg) injected intravenous prior to cesarean is effective to decrease anxiety and stress response from mothers, and not associated with adverse neonatal effects.
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