| ObjectiveThe general anaesthesia for caesarean section has some merits, including anesthesia induction being fast,without awareness during the operation and the quiet operative condition.Many clinical researchs indicate that the operative obstetric procedures under regional anaesthesia or general anaesthesia has the similar neonate Apgar score.Upt to now, about 20%-30%or more of caesarean section are performed under general anaesthesia.The general anaesthesia for caesarean section has some particularity:(1) the optimal anesthetic depth is required to prevent the operative awareness and disadvantage for fetus.(2) The quick anesthetic induction is required to prevent vomit backstreaming and aspiration because of the gastric emptying for caesarean section was prolonged.The ideal anesthetic method for caesarean section is that anesthetic induction is performed under the fast general anesthetic drug combined short muscle relaxant and the general anesthesia was maintained with inhalant anesthetic agnent before the expulsion of fetus. general anesthesia induced by propofol and celocaine for cesarean section is optimal,however,the investigation for it is seldom.Therefore,the present study is to observe the anaesthetic effect in pregnant and NBNA scores and Apgar scores of fetuses in general anesthesia induced by propofol and celocaine for cesarean section and to observe the propofol blood concentration of puerperas vein and fetuses umbilical vein in general anesthesia induced by propofol for cesarean section and to determine the effects on puerperas and fetuses and to evaluate its safety and availability.MethodsSixty parturients,ASAâ… -â…¡,were divided randomly into the general anesthesia group and epidural anesthesia group.The range of parturients age is 23～31 years and the range of parturients body weight is 59-98 Kg.The range of parturients body height is 156-169cm and the range of duration of pregnancy is 233～289d.All of the patients were monitored with ECG,HR,SpO2 and MAP.The parturients in GA group were positioned supine with a 15°left lateral tilt,and an i.v.preload of 500 ml saline 0.9%given.After 3 min of pre-oxygenation,Anesthesia was induced with 2mg·kg-1 propofol and 2mg·kg-1 succinylcholine.Mechanical ventilation were supported by anesthetic machine Excell210(breathing frequency 12bpm,vital volume 10ml·kg-1).At the same time,local anesthesia were performed with 1% lidocaine10～20ml and then the operation were set out.As soon as the fetus were taken out,fentanyl 2μg/kg and atracurium 0.3～0.6mg·kg-1 immediatelyintravenous injection Anaesthesia was maintained with 1.5% isoflurane,50%nitrous oxide and 50%oxygen.0.5h after the premedicant atropine 0.5mg were used,the parturients were in the right lateral position and epidural puncture were performed through the puncture point in L1-2.The epidural anaesthesia was administered using 2%lidocaine 3～5ml and 0.75%ropivacaine 8～10ml. The block level is up to T8.The BIS scores of the puerperas were recorded during the whole operation.The Apgar scores in 1min and 5min and NBNA scores in 3d and 10d of fetuses after expulsion were recorded and compared with those took cesarean section by epidural anesthesia.Blood samples withdrawn from maternal vein(MV),umbilical vein (UV),umbilical artery(UA)before ligature of the cord were studied by HPLC.ResultsThe No significant difference was seen between the two groups in Apgar and NBNA scores of newborn infants(P＞0.05).There was no introperative awareness according to the follow-up visit.The blood concentration of propofol in MV was 2.26±0.71μg·ml-1 and 0.83±0.25μg·ml-1 and 0.78±0.24μg·ml-1 in UV and UA respectively. There was no introperative awareness according to the follow-up visit. ConclusionThis study shows that cesarean section under general anesthesia induced by 2mg·kg-1 propofol and 2mg·kg-1 celocaine has no significant effect on Apgar and NBNA scores of the fetus,it can also provide active sedation to the puerperal. |
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