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Comparison of Maternal Stress Response to Midazolam/Fentanyl and Propofol During Cesarean Delivery Under Spinal Anesthesia: A Double-Blinded Randomized Controlled Trial

Background: This research evaluated the effects of propofol and midazolam/fentanyl on maternal blood pressure, heart rate, recall, and full satisfaction with spinal anesthesia. A double-blinded randomized controlled trial was designed. 
Methods: The sample size was calculated as 100 patients (a type I error of 5% and statistical power of 80%) who were scheduled for elective cesarean delivery under spinal anesthesia. These patients were randomized into two equal groups by block randomization used for allocation sequence: midazolam/fentanyl and propofol groups. We measured the maternal heart rate (HR), systolic, and diastolic blood pressure (SBP and DBP) before induction, every three minutes in the operating room, and every five minutes until discharge from the recovery room. Data were analyzed by SPSS 18.0 and P value < 0.05 was considered as the significance level. 
Results: 100 women (mean age: 29.7 ± 5.1 years and gestational age: 37.2 ± 1.2 weeks) were enrolled. The SBP and HR decreased during the study in both groups, but it was significant only in the midazolam/fentanyl group (SBP: from 120.0 ± 10.3 to 113.9 ± 4.8, P = 0.025; and HR: from 75.0 ± 7.6 to 65.3 ± 5.5, P = 0.046). DBP reduced in both groups, but it was only significant in the propofol group (from 68.5 ± 7.2 to 56.9 ± 2.1, P = 0.039). The maternal recall of the birth time, child weight, and full satisfaction were significantly better in the propofol group than in the midazolam/fentanyl group (P = 0.046, P = 0.009, and P = 0.039, respectively). 
Conclusions: Propofol and midazolam/fentanyl could be useful in cesarean sections under spinal anesthesia thought propofol may induce more effective sedation with higher satisfaction. Accordingly, the propofol use during caesarian sections under spinal anesthesia is suggested due to its anti-stress effects, good delivery recall, and good sedation satisfaction.