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

Abstract

Thirty mothers undergoing elective Caesarean section received thiopentone 3.5 mg kg-1 and 30 received etomidate 0.3 mg kg-1 for induction of anaesthesia. Subsequent management of anaesthesia was identical in both groups. Maternal to fetal base excess differences and the degree of biochemical correlation between mother and infant were more favourable following etomidate than following thiopentone. The clinical status of the newborn was considered superior with etomidate.

Fetal heart rate decelerations during ECT‐induced seizures: is it important?

“…The anesthetic agents may have contributed but, as succinylcholine crosses the placenta slowly and very little passes into the fetal circulation under most therapeutic doses, it is usually metabolized by the fetus (16). The chemical and biochemical status of the newborn are superior with an etomidate induction compared with thiopental (4). Antihypertensives, hyperventilation, or the use of atropine‐like agents were not employed in this case and therefore are not etiologies for the fetal cardiac decelerations, as they might be in some cases.…”

“…No lateral tilt was used. Before anesthesia induction, the patient received bicitra 30 ml per os and metoclopramide 10 mg i.v (3, 4). A blood pressure cuff was employed as a tourniquet to monitor motor activity.…”

“…The fetal heart rate remained at 140–160 b.p.m., both before and after each treatment. In the last three ECTs, etomidate 12 mg was substituted for the thiopental in an attempt to increase seizure duration (5, 6) and because of favorable experiences with the drug in obstetrical patients (4). On the 3rd ECT, the seizure duration did increase to 36 s from 18 s. There was no change noted in the fetal heart rate.…”

Traditional rapid sequence induction is an outmoded technique for caesarean section and should be modified

“…6 Dose-dependent neonatal respiratory depression is predictable and readily treatable by a neonatal paediatrician, who should be present to receive all babies born by caesarean section under general anaesthesia. Although thiopental is still regarded as the induction agent of choice for caesarean section, 7 etomidate, 8 propofol, 9 ketamine 10 and midazolam, 11 have all been used safely. Regardless of the chosen i.v.…”

Pharmacokinetic Optimisation of General Anaesthesia in Pregnancy

“…Etomidate is eliminated rapidly but has not been used widely despite it having a more favourable biochemical and clinical neonatal status compared with thiopental (Downing et al 1979). Neonatal cortisol production was suppressed after etomidate although there were no differences in the clinical condition of the neonates compared with those from a thiopental group (Reddy et al 1988) or a methohexital group (Crozier et al 1993).…”