Plasma Catecholamines and Neonatal Condition After Induction of Anaesthesia With Propofol or Thiopentone at Caesarean Section

Abstract

Increased maternal sympathetic nervous system activity may decrease placental perfusion and cause adverse neonatal effects. We have studied the catecholamine response and neonatal outcome in Chinese patients with uncomplicated, singleton pregnancies undergoing Caesarean section. Anaesthesia was induced with thiopentone 4 mg kg-1 (n = 32) or propofol 2 mg kg-1 (n = 30) followed by suxamethonium. Laryngoscopy was performed after 1 min and tracheal intubation completed by 2 min. Anaesthesia was continued with atracurium, nitrous oxide and isoflurane. Maternal venous blood samples were taken at 0, 1, 2, 3, 4 min and at delivery for assay of catecholamines. The increase from baseline values in mean arterial pressure after tracheal intubation was greater in the thiopentone group (29 (SD 15) mm Hg) compared with the propofol group (18 (14) mm Hg) (P < 0.01). The concentrations of noradrenaline and adrenaline increased in both groups after tracheal intubation. Maximum noradrenaline concentrations were greater in the thiopentone group (413 (177) pg ml-1) compared with the propofol group (333 (108) pg ml-1) (P < 0.05), but there were no differences between groups in adrenaline concentrations. Neonatal Apgar scores, neurobehavioural testing and umbilical catecholamine, blood-gas tension and oxygen content analysis were similar between groups. Propofol attenuated the hypertensive and catecholamine response associated with laryngoscopy and tracheal intubation but there was no improvement in neonatal outcome.

Variation in rapid sequence induction techniques: current practice in Wales

“…There have been several studies comparing propofol to thiopental for induction of anaesthesia for elective Caesarean section [20][21][22][23][24][25][26][27][28][29][30]. These have showed little difference in neonatal Apgar scores or umbilical blood gas analysis.…”

“…These have showed little difference in neonatal Apgar scores or umbilical blood gas analysis. Two studies [21,22] observed signs of lighter anaesthesia in the propofol group; however out of 516 women randomly allocated to propofol or thiopental [20][21][22][23][24][25][26][27][28][29][30] there were two episodes of recall, both occurring with thiopental [20,27]. Three studies [24,27,29] suggested an improved maternal recovery with propofol while four [20][21][22]30] found no difference.…”

Anesthetic management of a spontaneous spinal-epidural hematoma during pregnancy

“…For example, remifentanil, a rapid and short-acting opioid, has been successfully used to attenuate the hemodynamic and catecholamine responses following tracheal intubation in severe preeclamptic patients undergoing cesarean delivery. 11 Propofol also attenuates the pressor responses associated with laryngoscopy 12,13 and has no adverse effects on maternal hemodynamics, umbilical cord blood gases, Apgar scores and neurobehavioral scores. 13 In our case, we used only propofol (1.5 mg/kg) during anesthesia induction.…”

“…Delivery facilitated the prone position and decreased the risk of epidural bleeding. 12 Also, the fetus was spared exposure to radiation during spinal surgery.…”

Propofol ensures a more stable A-line ARX index than thiopental during intubation

“…9 Although cardiac inhibition and vasodilation from propofol may produce hypotension and bradycardia, [11][12][13] other commonly used general anesthetics, including thiopental, are similar. 11,14,15 For example, Mouren et al reported that propofol did not inhibit the myocardial performance of a blood-perfused isolated heart, but that thiopental did. 16 Therefore, cardiac inhibition or vasodilation might not be the only factor in the inhibition of hypertension and tachycardia which can be found during tracheal intubation with propofol anesthesia.…”