title: Bispectral index in assessment of 3% and 4.5% desflurane in 50% N2O for caesarean section.
abstract: BACKGROUND
  To prevent awareness and uterine atony among parturients during general anesthesia for caesarean section, volatile anesthetic agents have been limited to 0.5 MAC in 50% N2O. This technique appeared to be inadequate to produce BIS values less than 60 in isoflurane and sevoflurane.
  
  
  OBJECTIVE
  To assess BIS value during general anesthesia with 3% and 4.5% desflurane in 50% N2O before delivery.
  
  
  METHODS
  The parturients were blinded and randomized in opaque envelopes to one of the two study groups. Seventy-two elective caesarean section ASA I - II parturients were induced and intubated with thiopental 4 mg/kg, succinylcholine 1.5 mg/kg and were received either 3% or 4.5% desflurane in 50% N2O to maintain general anesthesia. Both groups received rocuronium 0.6 mg/kg for muscle relaxation. Morphine 0.1 mg/kg and midazolam 0.06 mg/kg were administered after delivery.
  
  
  RESULTS
  There were no differences in demographic data in both groups. The incidences of patients with a satisfactory BIS score (< 60) in the 4.5% desflurane group was 81% that was significantly more than 42% in the 3% desflurane group (p < 0.000). Mean BIS values at neonatal delivery were 62 +/- 8 in the 3% desflurane group, versus 49 +/- 12 in the 4.5% desflurane group. Indices of maternal and neonatal outcome were similar between the two groups.
  
  
  CONCLUSIONS
  General anesthesia for caesarean section with 4.5% desflurane in 50% N2O maintained BIS < 60 more significantly than 3% of desflurane in 50% N2O without maternal and neonatal adverse effects in healthy paturients.
authors.affiliation: Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Wichai
authors.initials: W
authors.lastname: Ittichaikulthol
authors.forename: Surirat
authors.initials: S
authors.lastname: Sriswasdi
authors.forename: Naruemol
authors.initials: N
authors.lastname: Prachanpanich
authors.forename: Jittiya
authors.initials: J
authors.lastname: Watcharotayangul
authors.forename: Rattaphol
authors.initials: R
authors.lastname: Seangrung
authors.forename: Wannipa
authors.initials: W
authors.lastname: Sithamwilai
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D018685:Anesthetics, Inhalation; D002585:Cesarean Section; D000077335:Desflurane; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D016343:Monitoring, Intraoperative; D009609:Nitrous Oxide; D011247:Pregnancy
chemical_list: D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane; D009609:Nitrous Oxide