Propofol Spinal Procedural Sedation for Cesarean Section

Can Propofol Procedural Sedation Implementation Increase the Acceptance of Spinal Anesthesia During Cesarean Section?

Patient's safety and satisfaction are major concerns of anesthesiologists and obstetricians. According to evidence, guidelines and quality markers, regional anesthesia is preferred over general anesthesia in obstetric surgery. A high level of anxiety is present in obstetric patients preoperatively. Patients with high anxiety tend to prefer general anesthesia for cesarean section. The anxiety can be reduced variably by non-pharmacologic and pharmacologic methods. The evidence supports the benefits of procedural sedation for distressed, anxious pregnant women.

Propofol provides short onset, rapid predictable action, anxiolysis and amnesia and it is more effective than benzodiazepines. Using propofol infusion in low doses during spinal injection in CS did not adversely affect the Apgar scores or the neurological and adaptive fetal outcomes. The general consensus is that procedural sedation is not a routine for spinal interventions, but required for anxious patients. Our hypothesis is that, with the high prevalence of maternal anxiety during cesarean section, ensuring painless comfortable spinal anesthesia may increase the acceptance rate of regional anesthesia during cesarean section.

Inclusion Criteria:

• Patients scheduled for elective cesarean section,
• Age: 18 - 40 years,
• American Society of Anesthesiologists I - III,
• Patients may present any of the following conditions:
• Respiratory diseases as bronchial asthma
• Hepatic compromise,
• Preeclampsia,
• Anemia with hemoglobin 10 g/dl,
• Previous sections,
• Obese with BMI more than 35%,
• Any criteria of difficult intubation, Compromised fetus as premature delivery, History of complications or non-satisfaction after general anesthesia during previous cesarean section,

Exclusion Criteria:

• Patients refusing to participate in the study,
• Known psychiatric disease,
• Addiction medications,
• Communication barrier,
• Absolute or relative contraindication for spinal anesthesia,
• Bad obstetric history, complicated pregnancy, congenital fetal anomaly.