Sevoflurane versus isoflurane in normal and pre-eclamptic parturients undergoing cesarean delivery

ABSTRACT

One hundred and twenty pregnant women were randomly assigned to receive either isoflurane two groups] or sevoflurane [two groups] using on open [non-blinded] study design. Anesthesia was maintained with either isoflurane 0.5% end tidal or sevoflurane 1% end tidal in combination with nitrous [N2O] 50% in oxygen. Liver functions, kidney functions, complete blood count and coagulation profile were measured and recorded. Pharmacokinetic study included serum inorganic fluoride concentration and kinetics of serum inorganic fluoride. Also, blood pressure, heart rate, central venous pressure [CVP] monitoring, ECG, estimation of intra-operative blood loss, uterine tone, recovery profile and urine in 24 hours were also studied. Infant outcome was also evaluated by Apgar score, neurologic adaptive capacity score [NACS], umbilical artery blood gas, acid base status and serum fluoride level. From the results obtained, it was concluded that sevoflurane appears to be similar to isoflurane with a few exceptions. It appears similar to isoflurane in its effect on regional blood flows including the hepatic and renal circulation. The use of sevoflurane resulted in faster emergence than after isoflurane. The high serum fluoride levels associated with administration of sevoflurane anesthesia were not dangerous, because it did not reach the level that cause nephrotoxicity. Neonatal outcomes were similar after anesthesia with either isoflurane or sevoflurane. So, sevoflurane 1.0% is a suitable alternative to isoflurane 0.5% for maintenance of anesthesia in such cases, but in this era of cost containment and rationing of health resources, it remains to be seen whether sevoflurane will supplant isoflurane for obstetrical anesthesia