General anaesthesia for caesarean section: is parturients cognitive functions improvement possible?

The aim – to study influence of general anaesthesia techniques on the cognitive functions after caesarean section.Materials and methods. Having agreed with local ethics committee and obtained informed consent, 64 pregnants (at 37–42 weeks gestation, who delivered by the caesarian section) were examined. The women were divided into two groups depending on maintenance of anaesthesia. For 1st group (n=30) was prescripted inhalation anaesthesia (IA). 2nd group (n=34) received total intravenous anaesthesia (TIVA). Criteria of exception were: age to 18 and 45 more than, term of pregnancy to 36 weeks, severe preeclamsia or eclampsia, decompensated extragenital pathology, diabetes mellitus, psychical diseases, signs of bacterial or viral infection, mycoses, abandonment of woman from participating in the research at any of it stages, use ketamine in an anaesthetic manual. IA: induction – thiopental sodium (5 mg/kg), maintenance – sevofluran 1.3 vol.% in fresh gas flow 1.5 L/min. Relaxation – suxcinilcholinum (1.0–1.5 mgs/kg). There were phentanyl (0,05 mgs/ ml (4 mls)) and diazepanum (10 mgs) after newborn extraction. Maintenance of analgesia is a phentanyl in a dose 0,05 mgs/ml (1 ml) having approaching of BIS by 60. ТIVА: induction – thiopental sodium (4 mgs/kg), relaxation – suxcinilcholinum 1.0–1.5 mgs/kg). Anaesthesia controlled by BISX Module, BISTM Covidient, USA in both groups. We used Montreal Cognitive Assessment test for cognitive functions investigation, "Matching digits and letters" test for control functions, "Drawing of clock" test for praxis. Control points: 1 – upon admission to the obstetrical department (P 1 ), in 24 hours after the surgery (P 2 ), on the 3rd day after the surgery (P 3 ), on the 5–7th day after the surgery (P 4 ).Results. The study showed cognitive functions go down to the moment of delivery or by 37th-42nd weeks of gestation, and control functions (speed of thinking, visually-motor coordination, cognitive control of activity), praxis go down too. There are means of cognitive functions do not change generally in a 24 hours after an caesarean section, neither under IA, nor at TIVA, and its remain on predelivery values. Praxis does not depend on the anaesthesia technique and remains decreased by 5–7th day after surgery.Conclusions. Cognitive functions depend on the anaesthesia technique: being initially decreased by 37th-42nd weeks of gestation, its are normalized to a 3rd day after surgery at IA. After TIVA cognitive functions remain decreased by 5–7th day after surgery. Cognitive control of activity is normalized after IA, remaining decreased after ТIVA.