Placental transfer and neonatal effects of propofol for cesarean section

Abstract

Objective To investigate the placental transfer and neonatal effects of propefol for cesarean section. Methods Sixty ASA Ⅰ or Ⅱ parturicnts at full term, aged 23-31 yr, weighing 59-98 kg, height 156-169 cm, undergoing elective cesarean section under general anesthesia, were randomly divided into 2 groups (n = 30 each): general anesthesia group (group G) and epidural anesthesia group (group E). Group G received iv injection of propofol 2 mg/kg and sueeinyleholine 2 mg/kg to facilitate tracheal intubation. Blood samples of 5 ml were drawn from umbilical vein (UV) and artery (UA), and maternal artery (MA) after ligation of the umbilical cords respectively for determination of plasma propofol concentrations (CUV, CUA and CMA) by HPLC. Epidural anesthesia was performed at L1,2 interspace, 2% lidocaine 11-17 ml was administered and the upper spread of sensory block reached T6-8. HB, SpO2 and MAP were recorded after the parturients had settled down for 5 min in the operating room (T0), at skin incision (T1), after delivery of the baby (T2), and at the end of operation (T3) in both groups. The delivery time (duration between uterus incision and delivery of the baby), duration between the end of administration and clamping of UA and UV, and Apgar score at 1 and 5 min after delivery were also recorded. Results The duration between the end of administration and clamping of UA and UV was significantly shorter in group G than in group E (P 0.05). No neonatal respiratory depression in both groups and no intraoperative awareness in group G occurred. The plasma concentrations of propofol were (1.4±0.4), (0.86±0.25) and (0.70±0.22) μg/ml in maternal arterial, and umbilical venous and arterial blood samples respectively. CUV/CMA and CUA/CUV were 0.61±0.11 and 0.80± 0.10 respectively. Conclusion The anesthetic efficacy of propofol 2 mg/kg was satisfactory for cesarean section, and it has no adverse effects on the newborn although the metabolism is slow after easy placental transfer. Key words: Propofol; Cesarean section; Infant, newborn; Placenta