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A Comparison of Propofol and Ketamine as Induction Agents for Cesarean Section

774

Ophas Wanna MD*, Thewarug Werawatganon MD**,
Sonthaya Piriyakitphaiboon MD***, Busakorn Taesiri MD****
* Department of Anesthesiology, Sappasitthiprasong Ubonratchatani Hospital
** Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University
*** Department of Obstetrics and Genecology, Sappasitthiprasong Ubonratchatani Hospital
**** Department of Pediatrics, Sappasitthiprasong Ubonratchatani Hospital

Abstract


Objective : To compare the neonatal and maternal effects of propofol and ketamine as induction agents for elective cesarean section
Design : Randomized, double-blind study.
Setting : Inpatient Obstetrics Department of Sappasitthiprasong Ubonratchatani Hospital, Ubonratchatani province, Thailand.
Intervention : 2 groups of 50 patients each receiving either 2mg/kg propofol or 1mg/kg ketamine for the induction of anesthesia.
Results : The time from the induction to cord clamping (I-C), the time from the uterine incision to cord clamping (U-C), the hemodynamic changes, sleep’ quality, dream, recall, awareness, Postoperative nausea & vomiting (PONV), and Apgar scores were studied. In the ketamine group Systolic Blood Pressure and Diastolic Blood Pressure rose about10-25% of the baseline after the induction, intubation, skin incision, and cord clamping (p < 0.001) while in the propofol group only the Heart Rate rose (p < 0.036) after the induction, the intubation, the skin incision, and cord clamping. Apgar scores, the I-C time, the U-C time, the age, the weight and total amount of methergin and oxytocin were not significantly different in both groups. No incidence of awareness, nightmare and ketamine’s phychomimetic side effects was found. The incidence of unpleasant light sleep, dreams and PONV was low. Most patients were willing to have the same anesthetic technique for the next cesarean section (81.3% of the propofol group& 86% of the ketamine group).
Conclusion : Both propofol and ketamine can be used as alternative induction agents to thiopental. The addition of sevoflurane immediately after the induction, together with the use of midazolam and morphine after delivery shall prevent awareness and ketamine’s phychomimetic side effects.However ketamine was cheaper and although Systolic Blood Pressure and Diastolic Blood Pressure were elevated they were within an acceptable range.

Keyword : Ketamine General anesthesia, Cesarean section, Low resource



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