Abstract
BackgroundAdministration of an optimal dose of anesthetic agent to ensure adequate depth of hypnosis with the lowest risk of adverse effects to the fetus is highly important in cesarean section. Sodium thiopental (STP) is still the first choice for induction of anesthesia in some countries for this obstetric surgery. We aimed to compare two doses of STP with regarding the depth of anesthesia and the condition of newborn infants.MethodsIn this clinical trial, parturient undergoing elective Caesarian section were randomized into two groups receiving either low-dose (5 mg/kg) or high-dose (7 mg/kg) STP. Muscle relaxation was provided with succinylcholine 2 mg/kg and anesthesia was maintained with O2/N2O and sevoflurane. The depth of anesthesia was evaluated using isolated forearm technique (IFT) and bispectral index (BIS) in various phases. Additionally, infants were assessed using Apgar score and neurobehavioral test.ResultsForty parturient were evaluated in each group. BIS was significantly lower in high-dose group at skin incision to delivery and subcutaneous and skin closure. Also, significant differences were noticed in IFT over induction to incision and incision to delivery. Apgar score was significantly lower in high-dose group at 1 min after delivery. Newborn infants in low-dose group had significantly better outcomes in all three domains of the neurobehavioral test.Conclusion7 mg/kg STP is superior to 5 mg/kg in creating deeper hypnosis for mothers. However, it negatively impacts Apgar score and neurobehavioral test of neonates. STP seems to has dropped behind as an acceptable anesthetic in Cesarean section.Trial registrationIRCT No: 2016082819470 N45, 13/03/2019.
Highlights
Determining the optimal dosage of anesthetic agents is challenging
Thiopental dose of 5–7 mg/kg has been described safe for induction of anesthesia in Caesarean section [4, 15], the dosage of medication should be adjusted so that the mother can benefit from satisfactory anesthesia, while the safety of the fetus in provided as well. We designed this randomized clinical trial to compare the effects of higher versus lower doses of Sodium thiopental (STP) on the depth of anesthesia with isolated forearm technique (IFT) and bispectral index (BIS) in the parturient and its side effects measured by Apgar score and neurobehavioral test in the newborns immediately after delivery. Material and methods This single blind randomized clinical trial was registered in Iranian Randomized Clinical Trial Registry (IRCT No: IRCT2016082819470N45, 13/03/2019), conducted in pregnant women with American Society of anesthesiologist (ASA) physical status I, II score scheduled for elective Cesarean section in Hafez hospital
The sample size calculation was performed according to our previous study on sodium thiopental 5 mg/kg [11], and a pilot study on thiopental 7 mg/kg, that the between-group difference in incidence of inadequate depth of anesthesia by IFT test was 25% approximately
Summary
Determining the optimal dosage of anesthetic agents is challenging This fact is a matter of concern in Caesarean section [1, 2]. Robust study on appropriate drug regimens to guarantee adequate depth of anesthesia during Caesarean section is surprisingly rare. This may be due to paucity of use of general anesthesia for Caesarean section and its application only in emergency situations when conducting randomized trials is extremely difficult. Administration of an optimal dose of anesthetic agent to ensure adequate depth of hypnosis with the lowest risk of adverse effects to the fetus is highly important in cesarean section. We aimed to compare two doses of STP with regarding the depth of anesthesia and the condition of newborn infants
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