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Purpose: Anaesthetic practice for caesarean section (C&S) has changed during the last decades. Although, general anesthesia (GA) for C&S still seems to be the method of choice in extremely urgent settings, past anesthetic evidence has shown that GA is with increased risk of anesthesia-related maternal and neonatal mortality. Rocuronium bromide (RB) provides the shortest onset of action of nondepolarizing blocking agents. Ketamine has been shown to improve intubating conditions when used in association with RB. Propofol is known to depress laryngeal reflexes. We investigated conditions of tracheal intubation and the Apgar scores of the newborn after administration optimum dose of RB-propofol-ketamine association for rapid sequence induction of anaesthesia in 86 parturients undergoing C&S.
Methods: After preoxygenation, then induced in rapid sequence with propofol 2mg/kg, ketamine 1mg/kg, RB 0.4 or 0.6mg/kg. Retrospectivly, the patients were evaluated intubating dose of rocuronium bromide, conditions of tracheal intubation and the Apgar scores.
Results: Tracheal intubation was being easily performed at 30 seconds after the administration of RB in all patients. At the end of the procedure, which lasted 25-40min, the T4/Tl ratio ranged >75%; neuromuscular blockade was not antagonized in 78 patients. Neuromuscular blockade was antagonized with a mixture of atropine 0.02mg/ kg and neostigmine 0.05mg/kg in 8 patients who induced 0.6mg/kg RB. Although having C&S for foetal distress undertaken, the Apgar scores at 1 and 5 minutes were >7 and >9 on the 86 neonates in this our survey.
Conclusions: The optimum dose of RB is 0,4mg/kg and propofol-ketamine association can be safely used for rapid sequence induction for C&S.