Effect Of Etomidate On Parturients And Newborns During Cesarean Section Under General Anesthesia

BackgroundCesarean section is one of the most common obstetrical operations in the world.Cesarean section is usually chosen for some women who are excessive fetal size,abnormal fetal position,too small pelvis and pregnancy-induced hypertension syndrome.Since the release of the national two-child policy in 2015,the number of elderly women with a cicatricial uterus is increasing,and the number of cesarean sections is also increasing year by year.Anesthesiologists play an important role in the cesarean section,the most commonly used anesthesia is spinal anesthesia.However,parturients have contraindications of spinal anesthesia,general anesthesia can only be used.Generally speaking,except for muscle relaxants,other anesthetic drugs are easy to pass through the placental barrier and affect neonatal respiration.Obstetrical anesthesia should not only meet the needs of surgery,but also ensure the safety of mother and child.Propofol is an intravenous hypnotic used to induce and maintain general anesthesia.Propofol has been used as an anesthetic inducer for cesarean section since the 20th century and is the standard for comparison of all new drugs.Propofol is an anesthetic drug confirmed by the FDA in the United States,which has little adverse effect on pregnant women and fetuses.However,propofol has a wide-ranging effect on the cardiovascular system and has a strong inhibitory effect on circulatory function,resulting in a decrease in systemic blood pressure with a decrease in cardiac output.Etomidate is the most commonly used inducer for general intravenous anesthesia.Etomidate,a fast-acting short-acting hypnotic drug for anesthesia induction,is highly fat-soluble and has been approved by the United States Drug Administration for use in older children and adults.The data currently available to guide the use of drugs in newborns and infants is inadequate.Moreover,many studies at home and abroad have shown that etomidate can inhibit adrenocortical function in other operations.However,this inhibitory effect is short-lived,and no side effects have been seen during and after surgery,which can be safely used in general anesthesia.Therefore,the purpose of this study was to investigate the effects of etomidate on parturients and newborns during cesarean section under general anesthesia.It is hoped that more research data will be provided to supplement the lack of literature and provide a basis for clinical protocols.ObjectiveTo estimate the effects of etomidate on maternal and neonatal in general anesthesia for cesarean section.MethodsWith the approval of the Ethics Committee of our hospital,and according to the inclusion and exclusion criteria,40 pregnant women who were admitted to our hospital from January 2017 to December 2018 were selected as the subjects of study,and the random number method was adopted.They were divided into the etomidate group（experimental group）and the propofol group（control group）.Record the general condition of the pregnant woman,including the age,weight,operation time,and amount of bleeding of the pregnant woman;record the general condition of the newborn,weight,sex,gestational age,and I-D（cutting to delivery of the fetus）;Systolic blood pressure,diastolic blood pressure and heart rate were observed and recorded at different time points before induction（T₁）,immediately after induction（T₂）,1 minute after intubation（T₃）,and 5 minutes after intubation（T₄）.The Apgar scores at 1,5 and 10 minutes after birth were recorded and neurobehavioral measurements were made at 3,14 and 28 days after birth.The values of PH,PCO2andPO2 in umbilical artery blood gas analysis were recorded.At the same time,blood cortisol was recorded in umbilical artery blood immediately after birth,and blood cortisol and blood glucose in heel vein were recorded 2 hours after birth.All data in this study were statistically analyzed using SPSS 23.0 statistical software.The normal distribution and variance measurement data were expressed as mean±standard deviation（x±s）.Analysis of variance was used for comparison between groups.Counting data such as gender comparisons were compared using the x² test.p<0.05 was considered statistically significant.Results1.There were no significant differences in age,body weight,operation time and bleeding volume between the two groups（p>0.05）.There was no significant difference in the weight,sex,gestational age and I-D time between the two groups（p>0.05）.2.There were no significant differences in systolic blood pressure,diastolic blood pressure and heart rate between the two groups at T₁and T₄（p>0.05）.The systolic blood pressure,diastolic blood pressure and heart rate of the two groups at the T₂ time were lower than those at the T₁ time,and decreased more obviously in propofol group,the difference was statistically significant（p<0.05）.The systolic blood pressure and diastolic blood pressure of the two groups were higher at T₃ than at T₂,and the difference was not statistically significant（p>0.05）.The systolic blood pressure,diastolic blood pressure and heart rate were lower in the T₂ and T₃ propofol groups than in the etomidate group（p<0.05）.3.There were no significant differences in Apgar score between the two groups of newborns at 1,5,and 10 minutes after birth（p>0.05）.4.There were no significant differences in the NBNA score between the two groups on the 3rd,14th,and 28th day after birth（p>0.05）.5.There were no significant differences in the PH value,PCO2 and PO2 values of umbilical arterial blood between the two groups（p>0.05）.6.There were no significant differences in blood glucose and cortisol between cord blood in the two groups（p>0.05）.In the two hours after birth,the blood glucose and cortisol of the etomidate group decreased,but within the normal range,the difference was not statistical significance（p>0.05）.Conclusions1.Etomidate showed higher hemodynamic stability after anesthesia induction,and had little effect on neonatal Apgar score,PH value,PCO2,PO2 and neonatal NBNA score.Etomidate could be safely used for anesthesia induction during cesarean section.2.The inhibitory effect of etomidate on adrenocortical function in neonates was limited,and cortisol in umbilical artery and calcaneal vein at 2 hours after birth was within the normal range.