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Intraoperative awareness is a potentially psychologically devastating complication of anesthesia associated with a high incidence of psychological sequalae, with post-traumatic stress disorders (PTSDs) being the most severe and causing high public concern, increases patients’ apprehension of surgery and leads to medical-legal issues regarding anesthesia (Leslie et al., 2010). Cesarean section (CS) under general anesthesia renders parturient patients at increased risk of inadequate anesthesia resulting in intraoperative awareness and subsequent recall higher than that reported in a general surgical population (Sandin et al., 2000).
We designed this study to investigate the effect of dexmedetomidine versus midazolam in reducing the risk of awareness guided by the bispectral Index when they are used as an adjuvant with general anesthesia after fetal expulsion in cesarean section, and comprised 60 patients were requesting general anesthesia for elective cesarean section. They were divided into 2 groups. group (A): (Midazolam group) 30 patients received intravenous bolus of 0.05 mg /kg was given to patients after fetal expulsion, and group (B): (Dexmedetomidine group) 30 patients received intravenous infusion of 1 μg/kg over 10 minutes after induction of general anesthesia, followed by a continuous infusion of 0.5 μg/kg/hour till closure of skin incision.
In our study, the BIS value was maintained between the values of (40:60) by using the study medication and supplemental doses of propofol, each dose contained 40 mg when needed. Both midazolam and dexmedetomidine showed comparable pattern. Our study showed non-significant difference (P.>0.05) at all-time points except for at the time of neonatal delivery and 3 min post-delivery when dexmedetomidine showed statistically significant lower BIS compared with midazolam.
Our study found the heart rate and blood pressure were significantly toward lower readings associated with dexmedetomidine patient group compared with midazolam patient group (P < 0.05) except for the latest two time points at eye opening and at extubation in blood pressure. These findings insured that use of dexmedetomidine lead to more hemodynamic stability than use of midazolam.
In this study, there was no statistically significant difference between midazolam patient group and dexmedetomidine patient group (p > 0.05) at all-time points of measurement with regard to end tidal carbon dioxide concentration and oxygen saturation.
In our study, the neonatal parameters showed that there was no statistically significant difference between midazolam patient group and dexmedetomidine patient group regarding neonatal apgar score at 1 and 5 min (p > 0.05).
Our study found the induction to delivery time and uterine incision to delivery time was the same in both groups and having no statistical significance in both groups (P< 0.05).
In our study, there was no significant difference between both groups as regard the post-operative awareness as there was no recalling of any intraoperative events.
In this study, the BIS values was maintained by study medication in addition to supplemental doses of propofol with no statistical significance in both groups as regarding that dose ( P< 0.05).