Evaluation of the adequacy of general anesthesia in cesarean section by bispectral index.

BACKGROUND: Awareness and recall, though not common, are the major hazards of general anesthesia, especially in Cesarean section (C/S) because of the absence of benzodiazepine and opioids for a significant time during anesthesia. In this study, the Bispectral Index (BIS), end-tidal isoflurane, and hemodynamic parameters were examined to evaluate the depth of the routine general anesthetic technique in C/S. METHODS: This study was carried out on 60 parturient patients undergoing elective C/S. A standardized anesthetic technique was applied: induction with Thiopental (4-5 mg/kg) and Succinylcholine (1.5-2 mg/kg) as well as maintenance with O2, N2O, and isoflurane. Electrocardiogram, heart rate, blood pressure, Spo2, end-tidal isoflurane concentration, BIS, and any clinical signs of inadequate depth of anesthesia such as movement, sweating, lacrimation, coughing, and jerking were continuously monitored and recorded at 16 fixed time points during anesthesia. RESULTS: A median BIS of less than 70 (range: 42-68) was obtained on all occasions during surgery; however, at each milestone, at least 20% of the patients had BIS values above 60. Hemodynamic parameters increased significantly in some patients, especially during laryngoscopy and intubation. No patient experienced recall or awareness. CONCLUSION: The currently used general anesthetic technique in our center appears inadequate in some milestones to reliably produce BIS values less than 60, which are associated with lower risk of awareness. Therefore, with respect to such desirable outcomes as good Apgar and clinical status in neonates, we would recommend the application of this method (if confirmed by further studies) through larger dosages of anesthetic agents.

Evaluation of Teaching Methods in Mass CPCR Training in Different Groups of the Society, an Observational Study.

To determine the efficacy of different methods of cardiopulmonary resuscitation (CPCR) training in 3 different groups of the society. In a prospective and observational study of 2000 individuals in 3 different groups including G1, G2, and G3 4 different protocols of CPCR training were applied and their efficacy was compared between the groups. Also, 12 months after the study course, 460 participants from 3 groups were asked to take apart in a theoretical and practical examination to evaluate the long-term efficacy of the 4 protocols. Among 2000 individuals took a parted in the study, 950 (47.5%) were G1, 600 (30%) were G2, and 450 (22.5%) were G3. G1 in 4 groups were 2.37 and 2.65 times more successful in pretest theoretical and 2.61 and 18.20 times more successful in practical examinations compared with G2 and G3 and gained highest improvement in CPCR skills. Other groups also showed significantly improved CPCR skills. Comparison of different methods of CPCR learning showed that the workshop using interactive lecture as well as human model, educational film, and reference CPCR book has the highest efficacy in all groups. This protocol of CPCR training showed more efficacy in long-term postdelayed evaluation. On the contrary, medical students had better long-term outcomes from the course. Although G1 and G2 obtained better results in learning CPCR skills, in G3 also the theoretical and practical knowledge were improved significantly. This course increased confidence for doing CPCR in all groups of the study. Considering that the most of the bystanders at emergency states are general population, training this group of the society and increasing their confidence about performing CPCR can be so effective and lifesaving at emergency states. (Clinical trial. Gov registration: NCT02120573).

Postoperative agitation in preschool children following emergence from sevoflurane or halothane anesthesia: a randomized study on the forestalling effect of midazolam premedication versus parental presence at induction of anesthesia.

OBJECTIVE: The effect of midazolam premedication on forestalling postoperative agitation in children is not yet concluded. The purpose of this study was to compare the effects of midazolam premedication and parental presence during anesthetic induction on the incidence of postoperative agitation in pediatric patients. METHODS: One hundred sixty-seven children between 2 years and 7 years of age, undergoing anesthesia for outpatient surgery, were enrolled and randomly divided into four groups: sevoflurane anesthesia with parental presence without premedication, sevoflurane anesthesia with oral midazolam premedication, halothane anesthesia with parental presence without premeditation, and halothane anesthesia with oral midazolam premedication. The children randomized to the premedication groups took oral midazolam 0.5mg/kg 20-30 minutes before anesthetic induction. For patients in the groups without premedication, one of the parents was present throughout the induction of anesthesia. One recovery room nurse blinded to the group assignment observed the patients and recorded the agitation scores all through their stay in the postanesthesia care unit. RESULTS: Postoperative agitation was significantly less in patients who received halothane anesthesia with oral midazolam premedication (p<0.002). CONCLUSION: Based on our data, the presence of a parent at induction of sevoflurance anesthesia was as effective as midazolam premedication in decreasing the incidence of postoperative agitation. Midazolam premedication, however, decreased postoperative agitation when halothane was used as the anesthetic agent.

Evaluation of the adequacy of general anesthesia in cesarean section by auditory evoked potential index: an observational study.

BACKGROUND: One of the hazards of general anesthesia for cesarean section (C/S) is the risk of intraoperative awareness with or without recall of the event. We examined the relationship between auditory evoked potential index (AAI), end-tidal isoflurane concentration and hemodynamic parameters to evaluate the adequacy of our routine general anesthetic technique in C/S. METHODS: This study was carried out in 70 parturients undergoing elective C/S. A standardized anesthetic technique was applied, including thiopentone and suxamethonium for induction, and O2, N2O and isoflurane for maintenance of anesthesia. AAI, heart rate, blood pressure, end-tidal isoflurane concentration and any clinical signs of inadequate depth of anesthesia such as movement, lacrimation and coughing or jerking were continuously monitored and recorded at 17 fixed time points during surgery and anesthesia. RESULTS: Mean arterial pressure and heart rate increased at intubation, but did not show a positive correlation with the AAI values during this time. The AAI subsequently changed in the same manner as the hemodynamic parameters. There were median AAI values of 43, 37 and 27 respectively during laryngoscopy, skin incision and the time of delivery. An Emax pharmacodynamic model of AAI and end-tidal isoflurane concentration showed an r2 of 0.35 (95% CI, 0.35-0.53). According to AAI values, the majority of patients (range, 48.5-61%) had a light level of anesthesia in the time from laryngoscopy up to uterine curettage and after that they experienced an adequate (surgical or deep) level of anesthesia (range, 62.3-80%). CONCLUSION: Our current general anesthetic technique appears to provide an inadequate depth of anesthesia, especially before uterine closure as a milestone. Also, we found a moderate correlation between AAI and end-tidal isoflurane concentration and, to a lesser extent, with heart rate and mean blood pressure during isoflurane-N2O anesthesia for C/S.