- •This is an extension study of a previous publication.
- •Women were randomised to receive rocuronium or suxamethonium for caesarean section.
- •There were more 1-min Apgar scores <7 with rocuronium.
- •There were no differences in 5-min or 10-min Apgar scores.
- •There were no significant differences in umbilical arterial blood gases.
In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample.
We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1 mg/kg (ROC n=245) or suxamethonium 1 mg/kg (SUX n=243) after propofol 2 mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases.
Data were analysed for 525 newborns (ROC n=263 vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores <7 at 1 min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5 min (ROC 8% vs. SUX 4.2%, P=0.1) or 10 min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes.
The use of rocuronium was associated with lower Apgar scores at 1 min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.
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Published online: May 09, 2017
Accepted: May 2, 2017The preliminary results of this study were presented at the following congresses: Euroanaesthesia 2013, Barcelona, Spain; Euroanaesthesia 2014, Stockholm, Sweden; Euroanaesthesia 2015, Berlin, Germany; Anesthesiology 2015, San Diego, USA; Euroanaesthesia 2016, London, UK.
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