COMPARATIVE ANALYSIS OF MULTIMODAL GENERAL ANESTHESIA TECHNIQUES IN CESAREAN SECTION

Introduction: Currently, there is no unified and standardized algorithm for general anesthesia during cesarean section. According to medical scientific literature, the main drawbacks of general anesthesia in the surgical procedure include a high risk of unintended intraoperative awareness (1:670) and a pronounced stress response to surgical trauma. Purpose: To compare the effectiveness of low-opioid multimodal general anesthesia with the «standard» multimodal anesthesia technique with mechanical ventilation during elective cesarean sections. Materials and Methods: We conducted a prospective, single-center, open, randomized cohort study, analyzing 60 clinical cases. Patients were randomly assigned (sealed envelope method) to two groups (30 people each): the first group received the «standard» multimodal technique of total intravenous anesthesia with artificial lung ventilation, and the second group used low-opioid multimodal general anesthesia with a reduction in intraoperative doses of anesthetic drugs (fentanyl, sodium thiopental) and the addition of continuous intravenous infusion of lidocaine after childbirth. Perioperative patient management and monitoring were conducted in accordance with the recommendations of the American Society of Anesthesiologists, with additional assessments of the bispectral index and stress-induced biomarkers (glucose, cortisol). Monitoring included Apgar scores of newborns, umbilical venous blood gas composition, anesthetic dosage, and perioperative course evaluation. Statistical analysis was performed using Student’s two-tailed t-test for independent samples, and in cases of non-normal distribution – the Mann-Whitney U test was applied. Differences were considered statistically significant when p < 0.05. Results: There was no statistically significant difference in baseline mean values between the two groups. The obtained results demonstrated significant advantages of low-opioid multimodal general anesthesia, including better mean arterial pressure, heart rate, and bispectral index scores after neonatal delivery (p < 0.001). No statistically significant differences were found in Apgar scores at 1 and 5 minutes (p > 0.05) or in the acid-base balance parameters (pH, pCO2 , pO2 ) of umbilical venous blood (p > 0.05). Additionally, lower glucose and cortisol levels were recorded at the end of the surgery (p < 0.001). Furthermore, patients in the second group experienced a more favorable postoperative course (p < 0.001), as evidenced by earlier mobilization, reduced length of stay in the anesthesiology and intensive care unit, higher satisfaction with anesthesia, and lower postoperative pain levels. Conclusions: The study results indicate that low-opioid multimodal general anesthesia with adjuvants (clonidine, acetaminophen, lidocaine) during elective cesarean section has statistically significant advantages over the standard multimodal general anesthesia technique.