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P.121
Maternal and foetal outcomes following propofol anaesthesia for emergency caesarean section
Board Board 7 / Wed 12:55, 11 May 2016

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Introduction

Thiopental remains the most commonly used drug for induction of general anaesthesia in emergency caesarean section in the UK. However the results of the 5th National Audit Project have led to a re-evaluation of thiopental’s role, with a number of commentators suggesting that propofol should be the induction agent of choice.

Research in elective caesarean sections suggests propofol is a safe drug in obstetric patients, but there is no systematic research into its safety in the emergency setting. In particular, in vitro data suggesting an increased risk of maternal haemorrhage has not been assessed in the clinical setting.

Introduction

Thiopental remains the most commonly used drug for induction of general anaesthesia in emergency caesarean section in the UK1. However the results of the 5th National Audit Project have led to a re-evaluation of thiopental’s role, with a number of commentators suggesting that propofol should be the induction agent of choice2.

Research in elective caesarean sections suggests propofol is a safe drug in obstetric patients, but there is no systematic research into its safety in the emergency setting. In particular, in vitro data suggesting an increased risk of maternal haemorrhage3-5 has not been assessed in the clinical setting.

Notes for 134 patients were screened, of whom 56 met the inclusion criteria.

Results are reported as mean ± standard deviation, median [interquartile range] and n (%).

Demographics for both groups were comparable (Table 1). Decision to delivery and induction of anaesthesia to delivery times were similar for both groups (22 vs. 29 minutes, P=0.51, and 6 vs. 10 minutes, P=0.50, respectively).

The mean dose of thiopental was 6.7 ±1.4 mg/kg and for propofol was 3.0 ±0.8 mg/kg.

No significant difference in estimated blood loss was found.

There was no significant difference in any of the secondary outcome measures (Table 2).

Foetal outcomes were also comparable between the two groups (Table 3).

Conclusions

In this retrospective study we found no evidence that the use of propofol for induction of general anaesthesia worsened maternal or foetal outcomes during emergency caesarean section.

We hypothesised that the propofol-induced reduction in uterine tone previously demonstrated in vitro would lead to increased blood loss during emergency caesarean section and that this had not been demonstrated in earlier studies because elective caesarean sections are associated with reduced bleeding. Our negative finding may instead reflect the in vitro observation that propofol exerts a dose-dependent effect on uterine muscle, with the doses used clinically being too small to affect uterine tone.

Patients in both groups in our study received relatively large doses of induction agent when compared to their booking weight, but it did appear that dose titration occurred more frequently in the thiopental group. Where the induction dose was recorded, a smaller proportion of the thiopental group received an entire ampoule of induction agent compared to the propofol group (21/43 (48%) vs. 9/11 (82%), p = 0.049).

The main limitations of this study are its small scale and retrospective nature, which limit both the size and accuracy of the data. However our results are consistent with the findings of larger studies in elective caesarean section, supporting our conclusion that propofol is a safe alternative to thiopental for induction of general anaesthesia in emergency caesarean section.

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