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Residual curarization in the neonate after caesarean section
C Perreault1, J Guay, P Gaudreault
1Department of Anesthesia, University of Montreal.
Summary
Atracurium showed lower transplacental transfer than d-tubocurarine during Caesarean sections. While initial newborn assessments were similar, atracurium was linked to transiently reduced neonatal muscle tone and neurological scores.
Area of Science:
- Anesthesiology
- Pharmacology
- Neonatal Medicine
Background:
- Neuromuscular blocking agents are used in Cesarean sections.
- Understanding transplacental transfer and neonatal effects is crucial for drug selection.
Purpose of the Study:
- To compare the transplacental transfer and neonatal effects of atracurium versus d-tubocurarine in Cesarean sections.
- To evaluate neonatal outcomes including Apgar and Neurological and Adaptive Capacity Scoring (NACS) tests.
Main Methods:
- A comparative study of 46 patients undergoing elective Cesarean section.
- Mothers received either atracurium (0.3 mg/kg) or d-tubocurarine (0.3 mg/kg).
- Transplacental transfer was assessed via feto-maternal ratios; neonatal status evaluated using Apgar and NACS scores.
Main Results:
- Atracurium demonstrated significantly lower transplacental transfer compared to d-tubocurarine (9% vs 12%).
- Neonatal Apgar scores were comparable between groups.
- At 15 minutes postpartum, fewer newborns in the atracurium group achieved normal NACS scores (55% vs 83%), with lower neck extension scores observed.
Conclusions:
- Atracurium has reduced placental transfer compared to d-tubocurarine.
- While Apgar scores are similar, atracurium may be associated with transient, mild neonatal neuromuscular impairment.
- Further research into long-term neonatal effects is warranted.