Effects Of Different Methods Of General Anesthesia In Cesarean Section On Infants And Maternals

Objective: To observe and compare the effects on infants and maternalsof the two different general anesthesia methods applied in cesarean section,and provide the basis for methods of general anesthesia for clinical cesareandelivery.Methods:1General informationThis experiment was to observe and compare40patients on cesareansection with general anesthesia between January2013and March2014, ASAⅠ～Ⅲ. Multiplets, premature birth, severe organ damages, disturbance ofconsciousness and mental abnormalities, known fetal distress and fetalabnormalities, hypertension or other existed complications related topregnancy were eliminated. Among them, Pregnancy with thrombocytopeniawere20people, pregnancy with aplastic anemia were5people, dangerousplacenta previa placenta implantation were13people, lumbar disc herniation1person, soliosis1person.2Experimental methods40patients under cesarean section with general anesthesia who met ourrequirements were randomly divided into two groups, intravenous inhalationanesthesia group（S group） and total intravenous anesthesia group(R group).Each group had20cases. S group was given8%sevoflurane, Oxygen flow6L/ml, propofol1.5mg/kg, and rocuronium0.6mg/kg for induction ofanesthesia. After endotracheal intubation, operation started. Before childbirthof fetal, we used end-tidal sevoflurane concentration of1.2%～1.3%, andpropofol2.5mg·kg-1·h-1to maintain anesthesia; R group was givenremifentanil1μg/kg. propofol1.5mg/kg, and rocuronium0.6mg/kg forinduction of anesthesia. After endotracheal intubation, operation started. Before childbirth of fatal, we used remifentanil0.05μg·kg-1·min-1, propofol2.5mg·kg-1·h-1to maintain anesthesia. When the surgery was to cut the uterus,all drug inhalation and infusion were stoped. Immediately after being fetalchildbirth, deepened the anesthesia. Midazolam0.05mg/kg,0.3sufentanilμg/kg, and propofol3～4mg·kg-1·h-1, remifentanil0.2～0.3μg·kg-1·min-1maintained anesthesia to the end of the surgery. We limited the time frominduction to childbirth less than10min, uterus cut to it3min. On the materalaspect, compared and recorded the systolic blood pressure (SBP), diastolicblood pressure (DBP), heart rate (HR), BIS of patients in the two groups at themoment of before induction(T0), after induction (T1), endotrachealintubation/surgery began(T2), fetal childbirth(T3) and the plasmaconcentration of enpinephrine and norepinephrine at the time of beforeinduction (T0), one minute after endotracheal intubation (T2-1), and fetalchildbirth (T3). Special drugs during the operation were recorded. We visitedthe materal on the Postoperative day，a week after the operation and a monthafter the operation to check whether there was a intraoperative awareness. Onthe neonate side, the pH value and blood gas analysis of the newbornumbilical arterial blood were tested instantly after childbirth, and Apgar scoreat1min,5min after childbirth. Neonatal recovery process and drug usagewas also recorded.Results:1Patients’ age, height, body weight, and the application of vascularactive drugs during the operation of two groups had no statistical differences.2Maternal hemodynamic parametersIn the two groups, SBP and DBP are lower at T1and T2，differenceswere statistically significant, P＜0.05. There was no difference between thetwo groups.In both groups, HR was faster at T1, T2, T3than T0, differences werestatistically significant in S group, P＜0.05, while no differences in the Rgroup, P＞0.05. Between the groups, at T1and T2, HR was faster in S groupthan R group, and differences were statistically significant, P＜0.05. 3Maternal stress responseAt the time of fetal childbirth, the plasma norepinephrineconcentration in the two groups both rised, comparing with T0, thedifference is statistical, P＜0.05.At T2plasma epinephrine concentration was lower in the R group thanT0, the difference was statistically, P＜0.05. At the time of fetal childbirth, theconcentration of epinephrine was higher in both groups, and it was higher in Sgroup than R group, the difference was statistical, P＜0.05.4The depth of anesthesia and intraoperative awarenessIn both groups, after induction of anesthesia, the BIS was lower in T1, T2and T3comparing with T0, the difference was statistical, P＜0.05. BIS waslower in S group than R group after induction, especially at T2and T3, thedifference was statistical, P＜0.05.There was no intraoperative awareness among materals in S groups, andthere was a case in R groups.5The newbornsThe umbilical arterial blood pH values were within the normal rangewhich was testing immediately after umbilical cord. there was no statisticallydifference between the two groups, P＞0.05.In both groups, the Apgar scores were higher at5min after childbirththan1min, and the difference was statistical, P＜0.05.Conclusion:1Both the anesthesia methods in two groups of can meet the operation.During the operation patients are hemodynamically stable. Newborns have noobvious respiratory and circulation depression.2The hemodynamics and stress reaction can be better controlled inremifentanil group than sevoflurane group, vital signs are more smoothly. Butthe depth of anesthesia may be better controlled in S group than R group, andmay better prevent the interaoperative awareness.