Clinical Research Directory

Evaluation of Consciousness Depth (qCON) and Analgesia Depth (qNOX) Indices in General Anesthesia

Objective: This prospective, single-center, observational clinical study aims to evaluate changes in qCON (hypnotic depth), qNOX (nociception/analgesia depth), EMG, and other parameters in patients undergoing elective cesarean section under general anesthesia, with a focus on the induction and maintenance phases. Background: Primary goals in cesarean anesthesia include maintaining adequate anesthetic depth to prevent awareness and intraoperative recall, preserving uterine tone, and avoiding neonatal respiratory depression. While high inhalation agent concentrations increase uterine relaxation and bleeding risks, opioids administered during the incision-to-delivery interval can cause neonatal respiratory depression. Alternative anesthetic combinations (e.g., ketamine-propofol) are used in practice, but their effects on EEG-derived indices (qCON and qNOX) and potential paradoxical shifts remain poorly defined. Methods: The study will be conducted at Erciyes University Faculty of Medicine Hospital in 140 patients planned for elective cesarean section under general anesthesia (alpha = 0.05, 90% power, effect size = 0.50), including a history of eclampsia, preoperative sedative use, and difficult intubation.

Ultrasound Versus Palpation for Determining Spinal Puncture Level in Cesarean Section

This study compares two methods of identifying the correct intervertebral level before performing spinal anesthesia in women undergoing elective cesarean delivery. In current practice, anesthesiologists locate the puncture site by feeling anatomical landmarks on the lower back (palpation of Tuffier's line). Ultrasound imaging offers an alternative in which the spine is scanned and the intended level is marked on the skin before the needle is inserted. It is not yet clear whether this additional step improves the success of the procedure or affects the mother's blood pressure and heart rate after the block. Sixty pregnant women scheduled for elective cesarean section will be randomly assigned to one of two groups. In one group, the puncture level will be determined by preprocedural ultrasound marking; in the other, by conventional landmark palpation. All other aspects of anesthetic care, including drug doses, will be identical in both groups. The main outcome is the proportion of patients in whom the subarachnoid space is entered successfully at the first attempt with a single skin puncture, producing a block adequate for surgery. Additional outcomes include the number of needle passes, procedure duration, changes in maternal blood pressure and heart rate, vasopressor requirement, sensory block level, and complications such as headache or back pain within 24 hours after surgery.