title: Evaluation of the adequacy of general anesthesia in cesarean section by bispectral index.
abstract: BACKGROUND
  Awareness and recall, though not common, are the major hazards of general anesthesia, especially in Cesarean section (C/S) because of the absence of benzodiazepine and opioids for a significant time during anesthesia. In this study, the Bispectral Index (BIS), end-tidal isoflurane, and hemodynamic parameters were examined to evaluate the depth of the routine general anesthetic technique in C/S.
  
  
  METHODS
  This study was carried out on 60 parturient patients undergoing elective C/S. A standardized anesthetic technique was applied: induction with Thiopental (4-5 mg/kg) and Succinylcholine (1.5-2 mg/kg) as well as maintenance with O2, N2O, and isoflurane. Electrocardiogram, heart rate, blood pressure, Spo2, end-tidal isoflurane concentration, BIS, and any clinical signs of inadequate depth of anesthesia such as movement, sweating, lacrimation, coughing, and jerking were continuously monitored and recorded at 16 fixed time points during anesthesia.
  
  
  RESULTS
  A median BIS of less than 70 (range: 42-68) was obtained on all occasions during surgery; however, at each milestone, at least 20% of the patients had BIS values above 60. Hemodynamic parameters increased significantly in some patients, especially during laryngoscopy and intubation. No patient experienced recall or awareness.
  
  
  CONCLUSIONS
  The currently used general anesthetic technique in our center appears inadequate in some milestones to reliably produce BIS values less than 60, which are associated with lower risk of awareness. Therefore, with respect to such desirable outcomes as good Apgar and clinical status in neonates, we would recommend the application of this method (if confirmed by further studies) through larger dosages of anesthetic agents.
authors.affiliation: Anesthesiology and Critical Care Research Center, Department of Anesthesiology, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sayed Mohammad Reza
authors.initials: SM
authors.lastname: Hadavi
authors.forename: Elaheh
authors.initials: E
authors.lastname: Allahyary
authors.forename: Saman
authors.initials: S
authors.lastname: Asadi
keywords: Awareness; Bispectral index; Cesarean section; Recall