Evaluation of Cardiovascular, Maternal, and Neonatal Outcomes with Three Different Dexmedetomidine Doses in Elective Caesarean Deliveries

Background: Numerous institutions routinely employ general anesthesia (GA) whenever a patient declines neuraxial anesthesia or if there is an urgent requirement for a cesarean delivery, despite central neuraxial blockade being the recommended approach. It is necessary to identify an effective medication and optimal dosage to mitigate the endocrine and hemodynamic responses during cesarean section under general anesthesia. Objective: To compare the effects of pre-operative "intravenous administration of dexmedetomidine (0.2, 0.4, and 0.6 g/kg/h) " on perioperative maternal hemodynamics and maternal as well as neonatal outcomes. Methods: 20 minutes prior to the induction of anesthesia, each of the three groups (n = 50 each) received an intravenous administration of 0.1 mL/kg/h of a solution containing 2, 4, and 6 mcg/mL of "dexmedetomidine (DEX 0.2, DEX 0.4, and DEX 0.6, respectively)". Infusion rates for two-thirds of the subjects were reduced to 0.03 mL/kg/h after peritoneal closure, so this adjustment was sustained until skin closure. Maternal outcomes, hemodynamic parameters, including neonatal outcomes have been recorded. Results: Group C (DEX 0.6) showed the lowest VAS scores for uterine relaxation, indicating better relaxation, and required the least supplementary oxytocin. Additionally, Group C had the highest sedation scores at 5 and 15 minutes, and the longest time to extubation. The quality of tracheal intubation was best in Group C, with the lowest MAC-Sevoflurane values after intubation and at 15 and 30 minutes postdelivery. The comparison of neonatal outcomes showed similar immediate neonatal health across all groups. Conclusion: The preoperative injection of dexmedetomidine at dosages of 0.4 or 0.6 mcg/kg/hour enhances uterine contractions and increases sedation levels.The hemodynamic and endocrine responses to caesarean section under general anesthesia were more effectively mitigated at these dosages.