Justification and implementation of the multimodal general anesthesia model for elective cesarean section into clinical practice
DOI:
https://doi.org/10.14739/2310-1210.2025.1.317596Keywords:
general anesthesia, total intravenous anesthesia, respiration, artificial, caesarean section, clonidine, paracetamolAbstract
General anesthesia for cesarean section serves as a reserve method and is used in cases when neuraxial anesthesia is contraindicated. Its total usage frequency accounts for approximately 20 % of all anesthetic techniques. Today, in medical practice, there is no unified general anesthesia protocol for obstetric patients. There are two main unresolved issues of general anesthesia for cesarean section: accidental awareness in patients during surgery (1:670 cases) and a manifest neuro-endocrine stress response of the body to surgical trauma.
Aim. To comparatively assess the efficacy of the conventional total intravenous anesthesia technique with mechanical ventilation and multimodal general anesthesia.
Materials and methods. In total, 60 cases of elective cesarean sections were analyzed. Patients were randomized into two groups of 30 individuals each. Group 1 (control group) received standard total intravenous anesthesia with mechanical ventilation. Group 2 (study group) received multimodal general anesthesia with additional adjuvants, including intravenous forms of paracetamol (1000 mg) and clonidine (100 µg), administered 30 minutes prior to surgery. Perioperative monitoring was carried out according to the recommendations of the American Association of Anesthesiologists with additional control of the bispectral index and levels of stress-induced substances (glucose, cortisol). The analysis included the newborn assessment on the Apgar scale, the measurement of umbilical cord blood gases, the evaluation of postoperative recovery and maternal satisfaction with anesthesia. For statistical analysis, unpaired two-tailed Student’s t-test was used to compare differences between normally distributed data and the Mann–Whitney U-test – when data were not normally distributed.
Results. Mean baseline characteristics have shown no statistically significant differences between the two groups (p > 0.05). At all planned stages of the scientific work, statistically significant differences (p < 0.001) were found in the examined indicators between the two groups: mean arterial pressure; heart rate; bispectral index; Apgar scores at 1 and 5 minutes; umbilical cord blood gas composition; blood glucose and cortisol levels. It has been noted that the postoperative period was better in Group 2 patients (p < 0.001): patient recovery time, length of intensive care unit stay, patient satisfaction with anesthesia).
Conclusions. Based on the results obtained, multimodal general anesthesia with adjuvants such as clonidine and acetaminophen administered prior to elective cesarean sections provides statistically significant advantages over the standard method of general anesthesia. The multimodal general anesthesia approach allows to improve the stability of hemodynamics, reduce the stress-induced response, ensure a better condition of newborns and quicker postoperative recovery.
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