| BackgroundAs an important part of the implementation of cesarean section, anesthesia is an important link to ensure the successful completion. Spinal anesthesia, nerve block anesthesia, local infiltration anesthesia and general anesthesia which are commonly used in clinical anesthesia have different indications and applicable people. How to select reasonable anesthesia drugs and methods is an important issue that must be considered in the implementation of cesarean section. Because of the special nature of parturient, minimizing the impact of anesthesia on parturient and newborn and guaranteeing their safety is extremely important. Typically, with the advantages of better narcotic effect and low adverse reactions, spinal anesthesia is regarded as the preferred method. But for patients who have contraindications and failure to spinal anesthesia, general anesthesia has become a very good alternative. In addition, the implementation of spinal anesthesia requests the parturient to stay awake and be able to cooperate with the anesthesiologists, but it is impossible for some parturient with mental illness and heavy psychological stress. In this case, general anesthesia becomes the only choice. In comparison with spinal anesthesia, although general anesthesia has a slightly higher risk for parturient and newborn, it is an important measure to achieve smooth delivery for women in the unconscious condition and has a great research value. It’s worth pointing out that with the advent of new narcotic drugs and the continuous improvement of anesthesia techniques, the risk of general anesthesia decreases gradually and the clinical advantages of general anesthesia applied in cesarean section become even more prominent. Compared with other methods of anesthesia, the general anesthesia used drugs are of many kinds and big dosage, and some drugs can have some impact on the fetus through the placenta circulation. How to choose the best narcotic drugs in order to protect the safety of parturient and fetus has important significance. This thesis has undergone deep researches on the specific impact of TIVA and intravenous-inhalation combined anesthesia on parturient and newborn and provide the clinical evidence for the application of general anesthesia in cesarean section.Materials and Methods1 Research Object1.1 Research sourcesApproved by the Ethics Committee and performed with strict inclusion and exclusion criteria, this experiment studied 62 patients undergone cesarean section under general anesthesia between January 2014 and May 2015.1.1.1 Inclusion criteria(1) the single full-term parturients(2) ASA classified as grade I ~ II(3) spinal anesthesia contraindications(4) without medical history of hypertension, diabetes(5) no history of drug allergy(6) no abnormal liver and kidney function 1.1.2 Exclusion criteria(1) history of mental illness(2) the patients or their families disagree1.2 Study object groupPerformed strictly of inclusion and exclusion criteria, 62 cases of parturients were selected ultimately as research subjects, and grouped into TIVA(group A)and intravenous-inhalation combined anesthesia(group B)group in accordance with the principle of randomization, the classification of ASA act as grade I ~II, and 31 patients in each group.2 Anesthesia methodsAfter entering the operating room, the patients was conducted paconventional oxygen inhaling and established peripheral venous pathway. The non invasive BP、ECG、 HR、Sp O2 BIS of the two groups were monitored. The A group was treated with general anesthesia inducing with administration of oxygen 5 minutes. The rapid-sequence induction was conducted with infusing intravenously with 2.0mg/kg propofol and 0.6mg/kg rocuronium bromide 2.5mg · kg-1· h-1propofol and 0.05μg?kg-1?min-1Remifentanil were applied to maintenance of anaesthesia before the umbilical cord ligation of the newborn. B group patients were treated as A group patients of the anesthesia inducing 0.05μg ?kg-1?min-1.Remifentanil and 1.2~1.3%Sevoflurane(concentration of the first second of expiration)were applied to maintenance of anaesthesia before the umbilical cord ligation of the newborn. The operation was carry out immediately after the successful endotracheal intubation. Both groups were asked that the mean time from the initial procedure of the operation to the fetal deliver was no more than 5 minutes and properly deepen the anaesthetic depth after the fetal deliver.3 Outcome measuresParturient aspect: The HR and BP of the two groups were recorded at the first time of the anesthesia inducing,the successful endotracheal intubation, the initial procedure of the operation and the fetal deliver. The concentration of noradrenaline and adrenaline in the parturient’s peripheral venous blood were recorded at the first time of the anesthesia inducing, the initial procedure of the operation and the fetal deliver. Newborn aspect: Record and compare the Apgar score separately after delivery in 1 minutes and 5 minutes.Result1 Effect of parturient1.1 At each time point, the SBP and DBP of group A and group B showed no significant difference(P>0.05), Compare the blood pressure value at different time point and at the time point of T0, the results showed that: The SBP and DBP of group B at the time point T2 and T3 have a significant decline relative to those at the time point T0, the difference had statistical significance(P<0.05);1.2 The concentration of plasma adrenaline and noradrenaline of group A and group B at the time point T2 increased significantly comparing with those at the time point T0, the difference had statistical significance(P<0.05).The difference had no statistical significance(P<0.05) between the two groups at each time point. The concentration of plasma adrenaline and noradrenaline of group A and group B at the time point T3 increased significantly, and that was higher in group B than in group A,the difference had statistical significance(P<0.05).1.3 In Group A, HR had no difference at each time point. The HR of group B at the time point T2 and T3 increased significantly comparing with those at the time point T0, and the difference had statistical significance(P<0.05).2 Effect of fetus2.1 There was no suppression on neonatal respiratory in the two groups. 2.2 At each time point, the Apgar score of the two groups showed no significant difference(P>0.05), but the Apgar score in the delivery for 5 minutes was significantly higher than that in the delivery for 1 minutes, the difference has statistical significance(P<0.05).ConclusionsThe two anesthetic regimen of TIVA and intravenous-inhalation combined anesthesia can meet the needs of cesarean section. The TIVA has little impact on the change of the parturient’s BP、HR and levels of stress hormones and has no suppression on neonatal respiratory. The TIVA can be applied in cesarean section safely. |
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