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Rocuronium versus suxamethonium for rapid sequence induction of general anaesthesia for caesarean section: influence on neonatal outcomes

  • M. Kosinova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • P. Stourac
    Correspondence
    Correspondence to: Assoc. Prof. Petr Stourac, MD, PhD, Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavska 20, Brno 625 00, Czech Republic.
    Affiliations
    Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • M. Adamus
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • D. Seidlova
    Affiliations
    2nd Anesthesiological Department, University Hospital Brno, Brno, Czech Republic
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  • T. Pavlik
    Affiliations
    Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • P. Janku
    Affiliations
    Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • I. Krikava
    Affiliations
    Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • Z. Mrozek
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • M. Prochazka
    Affiliations
    Department of Midwifery, University Hospital Olomouc, Faculty of Health Sciences, Palacky University Olomouc, Olomouc, Czech Republic
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  • J. Klucka
    Affiliations
    Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • R. Stoudek
    Affiliations
    Department of Pediatric Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • I. Bartikova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • H. Harazim
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • H. Robotkova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • K. Hejduk
    Affiliations
    Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • Z. Hodicka
    Affiliations
    Department of Obstetrics and Gynecology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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  • M. Kirchnerova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • J. Francakova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • L. Obare Pyszkova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • J. Hlozkova
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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  • P. Sevcik
    Affiliations
    Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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      Highlights

      • 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.

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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.

      Keywords

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