MATERNAL AND NEONATAL RESPONSES RELATED TO THE VOLATILE AGENT USED TO MAINTAIN ANAESTHESIA AT CAESAREAN SECTION

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Abstract
A standardized technique of general anesthesia, with 1 randomly selected variable, was provided for 237 patients undergoing elective and 540 undergoing emergency Cesarean section. The variable was the volatile agent used to maintain anesthesia, the choice resting between trichloroethylene (0.2 or 0.3 vol%) and halothane (0.2, 0.3, 0.4 or 0.5 vol%). No association was found between the type of agent and the duration of anesthesia, or the duration of either the I-D [induction to delivery] or the U-D [uterine incision to delivery] interval. A smaller total dose of suxamethonium was administered in conjunction with the higher concentrations of volatile agent. A statistically significant but clinically unimportant increase in the time elapsing from the cessation of anesthesia to maternal achievement of a safe level of consciousness was found with the higher concentrations. The incidence of maternal awareness plus unpleasant dreams was unacceptably high when the lower concentrations were used, and either trichloroethylene 0.3 vol% or halothane 0.4 or 0.5 vol% should be used. Neither agent, at these concentrations, was associated with neonatal depression in group A elective sections in which the fetus presented by the vertex, and although there was a possible tendency for their use in cases of fetal compromise to be associated with an increase in the incidence of neonatal respiratory depression, the degree of depression was of little consequence to neonatal well-being. Breech presentation and prolongation of the U-D interval are important determinants of depression and birth asphyxia among infants delivered by Cesarean section under general anesthesia.

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