Effects of propofol versus thiopental on Apgar scores in newborns and peri-operative outcomes of women undergoing emergency cesarean section: a randomized clinical trial.
BACKGROUND
General and regional anesthesia are the two main techniques used in cesarean section. Regional anesthesia is preferred, but under certain circumstances, such as by patient request and in patients with back deformities, general anesthesia is the only option. Commonly used induction agents include thiopental, ketamine, and propofol, depending on availability and the maternal clinical condition. The objective of this study was to investigate the effects of thiopental and propofol on the neonatal Apgar score and maternal recovery time following emergency cesarean section in order to determine the superior agent for mothers and neonates.


METHODS
This single-blinded randomized clinical trial included 150 ASA I and II patients block-randomized equally between the two study arms. Pregnant women at term scheduled to undergo cesarean section and their neonates were enrolled. The primary outcomes were the Apgar scores through 10-min postpartum, resuscitation requirement, and admission to the neonatal intensive care unit. The secondary outcome was the maternal recovery times.


RESULTS
At 0 min (umbilical cord clamp time), 43 (57.3%) neonates in the propofol group had an Apgar score < 7 compared with 31 (41.3%) neonates in the thiopental group (p = 0.05). The maternal recovery time was shorter in the propofol group than in the thiopental group (25 min vs. 31 min, respectively, p = 0.003).


CONCLUSIONS
Apgar scores do not differ significantly whether thiopental or propofol is used for anesthetic induction in women undergoing general anesthesia for an emergency cesarean section.


BACKGROUND
Pan-African Clinical Trial Registry (#PACTR201306000536344) http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_pageLabel=atm_portal_page_mytrials.
Department of Anesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. janattumukunde@gmail.com.
Janat
J
Tumukunde
Department of Anesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. ngisi2@yahoo.com.
Dlamini Diana
DD
Lomangisi
Department of Anesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. d4davidson@yahoo.co.uk.
Ocen
O
Davidson
Department of Anesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. kintuug2012@gmail.com.
Andrew
A
Kintu
Department of Anesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. ejokuj@gmail.com.
Ejoku
E
Joseph
Department of Anesthesia, Makerere University College of Health Sciences, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda. akwizera@chs.mak.ac.ug.
Arthur
A
Kwizera
D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001034:Apgar Score; D002585:Cesarean Section / Q000379:methods; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D015742:Propofol / Q000009:adverse effects*; D012151:Resuscitation / Q000706:statistics & numerical data; D016037:Single-Blind Method; D013874:Thiopental / Q000009:adverse effects*
D018686:Anesthetics, Intravenous; D013874:Thiopental; D015742:Propofol