Anaesthetic induction for Caesarean section with propanidid

Abstract

Propanidid is a good anaesthetic and analgesic agent, and, unlike the ultra shortacting barbiturates, it is non-cumulative. After intravenous injection into the maternal circulation at Caesarean section, propanidid crosses the placental barrier. Despite rapid equilibration between mother and foetus, reports indicate that drug-induced neonatal depression occurs infrequently after propanidid admini~tration.'-~ In contrast, the biodegradation of thiopentone is slow, as recovery from anaesthesia occurs by redistribution. Depression of the newborn at birth by barbiturates has been described, particularly when large doses of the drug areThe authors have previously detailed the use of propanidid as the sole anaesthetic agent for Caesarean ~e c t i o n .~ Their results confirmed the relative lack of drug induced neonatal depression with propanidid but the infants exhibited an undesirable degree of metabolic acidaemia with the technique described-a finding possibly related to the assumption of the supine position by the mother during surgery.**' This report describes the use of propanidid for the induction of anaesthesia at Caesarean section in the lateral tilt position. The results are compared with those of a previous similar series anaesthetised with thiopentone.' Material and methodsFifty patients in the lower socio-economic group were included in this study. All the mothers, who gave their consent to the investigation, fulfilled the criteria of Crawford's 'clinically acceptable ideal case'. There was no evidence of placental insufficiency, and the parturients were clinically free of serious systemic disease. Gestational age was between 36 and 42 weeks; cases of multiple pregnancy were excluded. The patients were not in labour and their membranes were intact. The pre-operative management of the mothers has been described in previous communications.'*" An infusion of Ringer's lactate solution was commenced in the

The neurobiology of central sensitization

“…Endogenous pain inhibitory networks can be activated in humans and animals during application of a noxious “conditioning” stimulus, resulting in attenuation of pain produced by a noxious “test” stimulus applied to a different body location—an effect termed conditioned pain modulation (CPM). Although deficient CPM (i.e., reduced inhibition of test stimulus evoked pain) or even facilitation of test stimulus pain has been observed in a subset of healthy individuals (Potvin & Marchand, ; Schoen et al., ), it is more common in individuals with FM and other COPCs (Granot et al., ; Julien, Goffaux, Arsenault, & Marchand, ; Kosek & Ordeberg, ; Le Bars, Dickenson, & Besson, ; Mahomedy, Downing, Jeal, & Coleman, ; Nir & Yarnitsky, ; Wilder‐Smith & Robert‐Yap, ; Yarnitsky et al., ). In fact, a 2012 meta‐analysis confirmed that CPM is attenuated in the majority of chronic pain conditions (Lewis, Rice, & McNair, ).…”

Etomidate for Induction of Anaesthesia at Caesarean Section: Comparison With Thiopentone

“…A review of the literature reveals that no induction agent investigated for Caesarean section has proved manifestly superior to thiopentone (Bradford and Moir, 1969;Baraka et al, 1971;Peltz and Sinclair, 1973;Downing et al, 1976;Mahomedy et al, 1976;Crawford, 1977). Indeed, James and others (1977) and Magno (1976) were unable to recommend lumbar extradural analgesia over a thiopentone, nitrous oxide, oxygen, volatile agent and relaxant anaesthesia for Caesarean section.…”

“…Thiopentone is a standard induction agent in obstetric anaesthesia (Bradford and Moir, 1969;Baraka et al, 1971;Peltz and Sinclair, 1973;Downing et al, 1976;Mahomedy et al, 1976). However, barbiturates cause some degree of cardiorespiratory depression, influencing maternal-fetal haemodynamics and transplacental exchange (Dundee and Wyant, 1974).…”

Peripartum general anaesthesia without tracheal intubation

“…Frightening hallucinations were infrequent and, when present, not completely controlled by benzodiazepines. Generally, in LSCS diazepam was not administered before the umbilical chord was clamped [4]. Consequently, neonates delivered by LSCS did not show drug‐induced depression of Apgar score as compared with spontaneously delivered babies.…”