Abstract
Ketamine was used as the sole anaesthetic during the induction-to-delivery interval in 20 full-term patients undergoing elective Caesarean section. The intravenous administration of ketamine 1.5 mg · kg−1 was followed by succinylcholine 1.5 mg · kg−1 and tracheal intubation. The mother’s lungs were then ventilated using 100 per cent oxygen until the baby was delivered. Intraoperative maternal awareness was assessed by the isolated forearm technique. The Apgar scores of the newborn at one and five minutes, as well as their umbilical vein blood gases were also evaluated and correlated with the induction-to-delivery (1-D) and the uterine incision-to-delivery (U-D) intervals. In 13 patients (Group A) the 1-D interval was < 10 min and U-D interval < 90 sec, while in seven (Group B) the 1-D interval was ≥ 10 min and the U-D interval ≥ 90 sec. The isolated arm test was negative in all patients having an 1-D interval < 10 min, and was positive in three patients when the 1-D interval exceeded ten minutes. The newborns of group A showed higher Apgar scores atone minute, as well as higher umbilical vein PO2 than was achieved in Group B. It was concluded that the technique used was not associated with maternal awareness or neonatal depression, provided that the 1-D interval was < 10 min and the U-D interval was < 90 sec.
Résumé
Lors de 20 césariennes électives chez des patientes à terme, nous n ’avons utilisé que de la kétamine comme anesthésique jusqu’au moment de la naissance. Après l’injection intraveineuse de 1,5 mg · kg−1 de kétamine et de 1,5 mg·kg−1 de succinylcholine, nous intubions la trachée et ventilions les poumons avec de l’ oxygène jusqu’ à la naissance. La présence d’un garrot isolant l’avant-bras du myorelaxant permettait de detecter un éventuel éveil intra-opératoire chez la mère. Nous mesurions l’Apgar à une et cinq minutes de même que les gaz veineux ombilicaux, le tout, en corrélation avec l’intervalle entre l’induction anesthésique et la naissance (A-N) et celui entre l’incision utérine et la naissance (U-N). Chez 13 patientes (Groupe A), ces intervalles étaient respectivement inferieurs à 10 min et à 90 sec tandis que chez les autres (Groupe B), ils étaient d’au moins 10 min et d’au moins 90 sec. Aucune des patientes dont l’intervalle A-N était inférieur à 10 min, ne manifesta de signe d’éveil, contrairement à trois patientes du Groupe B. Les nouveauxnés du Groupe A avaient un meilleur Apgar à une minute et une PO2 de la veine ombilicale plus élevée que ceux du Groupe B. II semble donc que cette technique ne s’accompagne pas d’éveil maternel ni de dépression néonatale si l’intervalle A-N est de moins de 10 min et l’intervalle U-N de moins de 90 sec.
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Baraka, A., Louis, F. & Dalleh, R. Maternal awareness and neonatal outcome after ketamine induction of anaesthesia for Caesarean section. Can J Anaesth 37, 641–644 (1990). https://doi.org/10.1007/BF03006482
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DOI: https://doi.org/10.1007/BF03006482