DESFLURANE - A NEW VOLATILE ANESTHETIC FOR CESAREAN-SECTION - MATERNAL AND NEONATAL EFFECTS

Desflurane, a new volatile anesthetic agent with low blood/gas solubility, has recently been studied in clinical and animal trials but its use in obstetrics has not been adequately evaluated. This prospective study was undertaken to evaluate the maternal and neonatal effects of desflurane in obstetrical patients. Seventy-five healthy parturients undergoing primary or repeat cesarean section were randomly assigned to one of three groups of 25 each, end-tidal 3% desflurane, 6% desflurane or 0.6% enflurane, combined with 50% N2O and O-2. All patients had rapid sequence induction of anesthesia with thiopentone sodium followed by succinyl choline for tracheal intubation. After delivery, anesthesia was maintained with reduced concentration of desflurane or enflurane with 67% N2O in O-2, supplemented by butorphanol tartrate. Maternal hemodynamic parameters, blood loss and maternal awareness during surgery were monitored. Neonatal outcome was evaluated by ApSar scores, neurological and adaptive capacity scores (NACS), cord blood gas and acid-base status, and lime to sustained respirat ion (TSR). Maternal blood loss did nor differ significantly between the three groups and none of the patients developed intraoperative awareness. All three groups responded to psychomotor performance equally fast. Patients in all three groups developed transient hypertension and tachycardia during induction of anesthesia which returned to baseline values in approximately 5 min. Neonatal outcome was equally good in the three groups. More neonates in the 6% desflurane group had TSR>90 s compared to the 3% desflurane group (P<0.05). It is concluded that desflurane in subanesthetic concentration is a safe supplement to N2O-O-2 mixture for cesarean section with the advantage of rapid and smooth recovery. 3% desflurane in N2O-O-2 seems to be an adequate concentration for cesarean section for the healthy parturient.