Optimization of general anesthesia for cesarean section

The aim is to compare the effectiveness of the "routine" technique of total intravenous anesthesia with artificial lung ventilation during elective cesarean section and low-opioid multimodal general anesthesia. Materials and methods. A prospective single-center open randomized cohort study was conducted, in which 60 clinical cases were analyzed. Patients were randomly divided into two groups of 30 people each: the first group received the "routine" technique of total intravenous anesthesia with artificial lung ventilation, the second - low-opioid multimodal general anesthesia with reduced intraoperative doses of fentanyl and sodium thiopental, as well as the addition of continuous intravenous infusion of lidocaine after childbirth. Additionally, the bispectral index and plasma levels of stress-induced substances (glucose and cortisol) were assessed. Newborns were assessed on the Apgar scale, the gas composition of umbilical venous blood, the dosage of anesthetic drugs and the course of the perioperative period. Results. Analysis of the study results revealed statistically proven benefits of low-opioid multimodal general anesthesia: better mean arterial pressure, heart rate, and bispectral index, higher Apgar scores of newborns, better acid-base status of umbilical venous blood, lower glucose and cortisol levels, which resulted in faster recovery after surgery, shorter ICU stay, higher satisfaction with anesthesia, and lower pain. Conclusions. Low-opioid multimodal general anesthesia with the addition of adjuvants (clonidine, acetaminophen, and lidocaine) during elective cesarean section has statistically proven advantages over the "routine" method of general anesthesia, by ensuring a satisfactory level of depth of anesthesia, hemodynamic stability, and a decrease in the body's stress response, which contributes to faster rehabilitation of patients after surgery and does not have a negative impact on newborns. The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. The authors declare that there is no conflict of interest.