Pre-Delivery Conscious Sedation with Intravenous Low Dose Thiopental Na Bolus during Spinal Anesthesia for Cesarean Section

  • Masoomeh Nataj Majd Mail Assistant professor of anesthesiology, ICU felloship Department of Anesthesiology, Arash Women’s Hospital, Tehran University of medical siences, Tehran, Iran
  • Nasrin Faridi Tazeh-kand Department of Anesthesiology, Arash Women’s Hospital, Tehran University of Medical Siences, Tehran, Iran.
  • Ladan Hoseini Research Promotion Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mahdi Sepidarkish Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Centre, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
Keywords:
Sedation, Thiopental Na, Spinal anesthesia, Cesarean section

Abstract

Background: Nowadays, according to the large number of cesarean sections under spinal anesthesia, finding a simple and safe pre-delivery sedation technique which provides satisfaction for mothers with no over sedation and amnesia seems to be necessary. However, there is not enough evidence about the best choice of drug for this purpose. In the present study we aimed in evaluating the clinical effects of different concentrations (0.25, 0.5, 0.75mg/kg) of thiopental Na bolus for the mother’s satisfaction in cesarean section under spinal anesthesia.
Methods: Two hundred and forty term singleton pregnant women with normal ASA physical status were scheduled for an elective term cesarean delivery under spinal anesthesia and allocated into four groups. Groups I, II, III received 0.25, 0.5, 0.75mg/kg/IV of Thiopental Na respectively and group IV as the control group received 1.5cc of sterile water,1 min after spinal anesthesia. The level of consciousness with observer assessment of alertness/sedation score (OAA/S) and mother’s satisfaction was considered as primary outcomes.
Results: The level of mothers’ satisfaction in group II was significantly higher than other groups without any over sedation (P<0.001) and no adverse effect on their verbal contact was observed and they could easily communicate. All women could remember their infants. All babies were healthy with no complications and the Apgar scores were the same in all studied groups.
Conclusion: Based on the results of the present study and with comparison of different concenfrations and side effects indicates pre-delivery conscious sedation with 0. 5 mg/kg/IV of Thiopental Na could be a safe and appropriate technique for sedation in cesarean sections surgery under spinal anesthesia.

References

[1] Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology. 1997; 86(2):277-84.
[2] Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Gynecol Obstet Invest. 2003; 55(1):41-5.
[3] Saha DK, Rahman M, Sarkar PC, Banik D, Hudaak Q, Begum F. The effect of low dose pethidine and diazepam for sedation in Cesarean Section under Sub-Arachnoid Block on mothers’ satisfaction. Bangladesh Journal of Obstetrics & Gynaecology. 2009; 24(1):10-3.
[4] Pollock JE, Neal JM, Liu SS, Burkhead D, Polissar N. Sedation during spinal anesthesia. Anesthesiology. 2000; 93(3):728-34.
[5] American Society of Anesthesiologists Task Force on S, Analgesia by N-A. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002; 96(4):1004-17.
[6] Shahriari A, Khooshideh M, Heidari MH. Prevention of nausea and vomiting in caesarean section under spinal anaesthesia with midazolam or metoclopramide? J Pak Med Assoc. 2009; 59(11):756-9.
[7] Frölich MA, Burchfield DJ, Euliano T, Caton D. A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neontal effects. Can J Anaesth. 2006; 53(1):79-85.
[8] Senel AC, Mergan F. Premedication with midazolam prior to caesarean section has no neonatal adverse effects. Braz J Anesthesiol. 2014; 64(1):16-21.
[9] Sen S, Ozmert G, Aydin ON, Baran N, Caliskan E. The persisting analgesic effect of low-dose intravenous ketamine after spinal anaesthesia for caesarean section. Eur J Anaesthesiol. 2005; 22(7):518-23.
[10] Cheng YJ, Wang YP, Fan SZ, Liu CC. Intravenous infusion of low dose propofol for conscious sedation in cesarean section before spinal anesthesia. Acta Anaesthesiol Sin. 1997; 35(2):79-84.
[11] Birnbach DJ, Browne IM. Anesthesia for obstetrics, Miller’s anesthesia. Philadelphia: Churchill-Livingstone; 2010.
[12] Lee-Jayaram JJ, Green A, Siembieda J, Gracely EJ, Mull CC, Quintana E, et al. Ketamine/midazolam versus etomidate/fentanyl: procedural sedation for pediatric orthopedic reductions. Pediatr Emerg Care. 2010; 26(6):408-12.
[13] Akhlaghpoor S, Shabestari AA, Moghdam MS. Low dose of rectal thiopental sodium for pediatric sedation in spiral computed tomography study. Pediatr Int. 2007; 49(3):387-91.
[14] Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, et al. Validity and Reliability of the Observer's: Assessment of Alertness/Sedation Scale: Study with: Intravenous Midazolam. J Clin Psychopharmacol. 1990; 10(4):244-51.
[15] Riavis M, Laux-End R, Carvajal-Busslinger MI, Tschappeler H, Bianchetti MG. Sedation with intravenous benzodiazepine and ketamine for renal biopsies. Pediatr Nephrol. 1998; 12(2):147-8.
[16] Nishiyama T. Propofol infusion for sedation during spinal anesthesia. J Anesth. 2007; 21(2):265-9.
[17] Patki A, Shelgaonkar VC. A comparison of equisedative infusions of propofol and midazolam for conscious sedation during spinal anesthesia - a prospective randomized study. J Anaesthesiol Clin Pharmacol. 2011; 27(1):47-53.
[18] Nishiyama T. Propofol infusion for sedation during spinal anesthesia. J Anesth. 2007; 21(2):265-9.
Published
2019-12-29
How to Cite
1.
Nataj Majd M, Faridi Tazeh-kand N, Hoseini L, Sepidarkish M. Pre-Delivery Conscious Sedation with Intravenous Low Dose Thiopental Na Bolus during Spinal Anesthesia for Cesarean Section. Arch Anesth & Crit Care. 6(1):8-5.
Section
Research Article(s)