Sedation in obstetrics and gynecology
Authors: Hryzhymalskyi Ye.V. 
Published: July 2021

Background. Sedation is a controlled medical depression of consciousness with the preservation of protective reflexes, independent effective breathing and response to physical stimulation and verbal commands. Requirements for sedation include rapid onset of effect, short action, minimal impact on the cardiorespiratory system, lack of delirium and emetic effect. The goals of sedation include patient comfort, minimization of pain and discomfort, anxiolysis, amnesia, control of patient behavior, rapid recovery.

Objective. To describe the features of sedation in obstetrics and gynecology.

Materials and methods. Analysis of literature data on this topic; own research. The study included 64 women with gynecological diseases who underwent elective surgery under regional anesthesia. Longocaine and Longocaine Heavy (“Yuria-Pharm”) were used as local anesthetics. Sedation by dexmedetomidine ("Yuria-Pharm") was used in group 1, and by propofol in group 2.

Results and discussion. Cesarean section is characterized by high levels of stress. The main requirements for sedation during caesarean section include the preservation of consciousness, self-breathing and protective reflexes of the respiratory tract, minimal impact on hemodynamics, short duration of action of drugs. Subjective methods (different scales, verbal contact with the patient, assessment of pupil dilation, pulse, respiratory rate, blood pressure) and objective methods (electroencephalography, BIS spectral index) are used to determine the degree of sedation. Mandatory monitoring during sedation includes non-invasive blood pressure measurement, pulse oximetry, electrocardiography, capnography, BIS monitoring. Capnography is the most effective type of monitoring. For the safety of procedure carefully trained personnel, the device for mechanical lung ventilation, a set for ensuring passability of respiratory tracts, a defibrillator, and drugs for emergency medical care are necessary. For procedural sedation, drugs such as propofol, barbiturates, benzodiazepines, dexmedetomidine, ketamine, and inhalation anesthetics are used. The advantages of benzodiazepines are rapid effect and amnestic action, the disadvantages include the promotion of delirium and respiratory depression, no analgesic effect. The last two effects are also typical for propofol, which also causes pain in the vein during administration and the propofol infusion syndrome. The advantages of propofol include rapid onset of effect and rapid awakening, ease of titration, amnestic and antiemetic action. Ketamine also provides a rapid onset of effect and rapid awakening, and has an analgesic effect, however, causes hallucinations and hypersalivation, increased motor activity. Dexmedetomidine is an analgesic, has a sedative effect and a minimal effect on respiratory status. Disadvantages of dexmedetomidine include slow onset of effect and dose-dependent decrease in blood pressure. A number of scientific studies indicate the absence of adverse effects of dexmedetomidine during cesarean section under regional anesthesia. According to our own study, sedation with dexmedetomidine caused hypotension 26.5 % less often than sedation with propofol. Targeted sedation with dexmedetomidine caused almost no respiratory depression, whereas sedation with propofol led to moderate hypoxemia in 21 % of patients and severe hypoxemia in 35.9 % of patients. Dexmedetomidine contributed to a more pronounced reduction in pain, which can be explained by its own analgesic effect.

Conclusions. 1. The goals of sedation include patient comfort, minimization of pain and discomfort, anxiolysis, amnesia, control of patient behavior, rapid recovery. 2. The main requirements for sedation during caesarean section include the preservation of consciousness, independent breathing and protective reflexes of the respiratory tract, minimal impact on hemodynamics, short duration of action of drugs. 3. Capnography is the most effective type of monitoring during sedation. 4. Sedation with dexmedetomidine caused hypotension 26.5 % less often than sedation with propofol. 5. Targeted sedation with dexmedetomidine caused almost no respiratory depression. 6. Dexmedetomidine contributed to a more pronounced reduction in pain than propofol.