title: Awareness and apgar score in elective Cesarean section under general anesthesia with propofol or Isoflurane: A prospective, randomized, double-blinded clinical trial study.
abstract: BACKGROUND
  Awareness is a postoperative recall of events experienced under general anesthesia. In this study, we compared the incidence of awareness between two routine methods used, inhalation (Isoflurane) and intravenous protocol (Propofol), in elective Cesarean section, and also evaluated the effect of these two different methods on the apgar score of newborns.
  
  
  METHODS
  In this prospective, clinical trial study, 90 pregnant women candidates for elective Cesarean section were randomly enrolled, after taking written consent. Induction of anesthesia in both groups was provided by propofol and succinylcholine in the same manner, and maintenance of anesthesia in Group 1 was provided by propofol 100 μg/kg/minute and in Group 2 with isoflurane 1 MAC, to maintain the bispectral index (BIS) between 45 and 60. Blood pressure, heart rate, electrocardiography (ECG), and also Etco2 and o2sat were recorded throughout the surgery and finally analyzed and compared.
  
  
  RESULTS
  From 90 patients, four cases of confirmed awareness were found in the propofol group and three cases in the Isoflurane group (8/9% vs. 6/7%), but the apgar scores were comparable between the two groups. Meanwhile there were no significant differences between the two groups in basic information, neonatal apgar scores, hemodynamic changes, and BIS, Electromyography (EMG), and signal quality index (SQI) values.
  
  
  CONCLUSIONS
  According to the patient's state, diagnosis of the anesthesiologist, and other criteria like price and its availability, we could use these drugs in general anesthesia during Cesarean section, although it is recommended that more studies be done to compare the effect of these two drugs in larger groups.
authors.affiliation: Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Khanjani
authors.affiliation: Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Khosrou
authors.initials: K
authors.lastname: Naghibi
authors.affiliation: Azad University of Medical Sciences, Isfahan, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Azarnoush
keywords: Apgar score; BIS; Isoflurane; awareness; propofol