Comparing Inhalational Anesthesia and TIVA on Maternal and Neonatal Hemodynamics in Elective Cesarean Section

Comparing The Effects Of Inhalational Anesthesia And Total Intravenous Anesthesia On Maternal And Neonatal Hemodynamic Dynamics In Elective Cesarean Section: A Prospective, Double-Blind, Randomized Controlled Trial

This prospective, double-blind, randomized controlled trial compares the effects of total intravenous anesthesia (TIVA) versus sevoflurane-based inhalational anesthesia on maternal hemodynamics, depth of anesthesia, and early neonatal clinical outcomes in pregnant women undergoing elective cesarean section under general anesthesia

Elective cesarean sections under general anesthesia present a unique clinical setting where maternal ventilation and depth of anesthesia directly influence uteroplacental circulation and neonatal adaptation. This single-center study included 80 pregnant women (ASA physical status II, 38 weeks of gestation or more) randomly allocated into two groups: the TIVA group (n=39) receiving propofol and remifentanil, and the Sevoflurane group (n=41) receiving sevoflurane and fentanyl. The study evaluates intraoperative maternal hemodynamics, Bispectral Index (BIS) monitoring for depth of anesthesia, postoperative pain using the Numeric Rating Scale (NRS), and neonatal outcomes including Apgar scores, the Neurologic and Adaptive Capacity Score (NACS), and umbilical cord blood gas analysis.

Inclusion Criteria:

• Pregnant women scheduled for elective cesarean section under general anesthesia.
• Gestational age of 38 weeks or greater.
• American Society of Anesthesiologists (ASA) physical status II.

Exclusion Criteria:

• Emergency cesarean section (Category 1 and 2).
• Presence of fetal distress. * ASA physical status III or higher.
• Preference for regional anesthesia.
• Antenatally detected fetal anomalies.
• Multiple pregnancies.
• Estimated birth weight less than 2400 grams.
• Known allergy to the study drugs or intraoperative adverse drug reactions.
• Severe eclampsia.
• Patients requiring conversion to general anesthesia due to inadequate spinal block.