Plasma catecholamines and neonatal condition after induction of anaesthesia with propofol or thiopentone at caesarean section.
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.
Gin
T
T
Department of Anaesthesia & Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
O'Meara
M E
ME
Kan
A F
AF
Leung
R K
RK
Tan
P
P
Yau
G
G
D000328:Adult; D000773:Anesthesia, Obstetrical; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009638:Norepinephrine / Q000097:blood*; D010100:Oxygen / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D015742:Propofol; D013874:Thiopental; D013997:Time Factors
D013874:Thiopental; D010100:Oxygen; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine