Propofol infusion anaesthesia for Caesarean section

Abstract

Propofol infusions for the maintenance of anaesthesia during Caesarean section may offer some advantages. Recovery from propofol infusion is rapid 1-5 and this would be desirable for mothers who are still at risk from acid aspiration in the postoperative period. The rapid recovery characteristics of propofol may also be beneficial for the neonate after delivery. However, placental transfer of propofol is rapid 6 and infusions present the fetus with a large dose of drug which may cause neonatal depression after delivery. Decreases in blood pressure after propofol have been reported, 7 and often to a greater degree than with thiopentone, s'9 This could be detrimental to placental perfusion and neonatal outcome. Nevertheless, studies during maintenance of anaesthesia show similar haemodynamic profiles in patients given propofol infusions compared with inhalational agents. 1.2,4High inspired maternal oxygen concentrations may be beneficial for the fetus at risk of intrauterine asphyxia, i0 A propofol infusion may permit the use of 100 per cent oxygen without risk of maternal awareness or the need for higher concentrations of volatile agent.This study evaluated propofol infusions for Caesarean section. Two different infusion regimens and a standard thiopentone, enflurane and nitrous oxide general anaesthetic were compared. One infusion regimen substituted CAN J ANAESTH 1990 / 37:5 / pp 514-20

A comparison of the haemodynamic effects of propofol and isoflurane in pregnant ewes

“…While much information exists for maintenance of anaesthesia with inhalation agents in pregnant women, there is little information about maintenance of anaesthesia with propofol ( Gregory et al ., 1990 ). The literature indicates that neonatal Apgar scores, blood gas analyses, maternal recovery times and psychomotor performance are comparable to pregnant women administered thiopental ( Gregory et al ., 1990 ). To our knowledge, no papers directly compare the maternal and foetal haemodynamic effects of propofol infusion and inhaled isoflurane in pregnant ewes without the effects of other drugs.…”

“…General anaesthesia is performed for about 41% of Caesarean sections ( Gibbs et al ., 1986 ) for several reasons including quickness of induction, patient and anaesthesiologist preference and better control of the patient’s airway and ventilation. General anaesthesia is indicated for emergency Caesarean section because onset of action is quick, allowing rapid delivery of the newborn, minimizing maternal hypotension, ( Gregory et al ., 1990 ) thus decreasing the likelihood of additional foetal stress.…”

Management of glioblastoma multiforme in pregnancy

“…General anesthesia may consist of induction with either propofol or thiopental plus a volatile anesthetic for maintenance or induction and maintenance with intravenous propofol. 50 Gregory et al 15 reported low neurological adaptive capacity scores in mothers on a maintenance infusion of propofol at 2 hours, but this had completely abated by 24 hours. There should be sufficient left lateral tilt while the patient is on the operating table to avoid aortocaval compression.…”

Anesthesia for urgent sequential ventriculoperitoneal shunt revision and cesarean delivery

“…26 Propofol infused at 9 mgAEkg À1 h À1 to maintain anesthesia for elective cesarean delivery has been associated with lower neurologic and adaptive capacity scores than propofol 6 mgAEkg À1 h À1 . 27 In a recent report of 13 newborns delivered by semi-elective cesarean delivery, anesthesia with propofol (5 and 2.5 lg/mL target plasma concentrations, before and after intubation) and remifentanil (0.5 lg/kg bolus followed by 0.20 lgAEkg À1 min À1 continuous infusion) resulted in Apgar scores <7 in six babies at 1 min and two babies at 5 min. 28 Mask ventilation was necessary for 1 to 5 min and Apgar scores were above 8 in all neonates by 10 min.…”