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Anaesthesia for Caesarean section with ketamine

J W Downing, M C Mahomedy, D E Jeal

    Anaesthesia
    |September 1, 1976
    PubMed
    Summary
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    Ketamine anesthesia for Cesarean sections showed improved maternal and fetal blood gases compared to thiopentone. However, it was associated with some neonatal depression and potential maternal hallucinations, suggesting a need for dose re-evaluation.

    Area of Science:

    • Anesthesiology
    • Obstetrics
    • Neonatology

    Background:

    • Cesarean sections require careful anesthetic management to ensure maternal and fetal well-being.
    • Previous anesthetic agents have demonstrated varying impacts on maternal and neonatal outcomes.
    • Ketamine is an anesthetic agent with potential benefits and risks in obstetric procedures.

    Purpose of the Study:

    • To compare the effects of ketamine anesthesia versus thiopentone anesthesia on maternal and fetal blood gases during Cesarean sections.
    • To evaluate neonatal outcomes, including Apgar scores and time to sustained respiration, following ketamine anesthesia.
    • To assess maternal side effects such as awareness, hallucinations, and dreams associated with ketamine use.

    Main Methods:

    • Fifty healthy mothers undergoing Cesarean section received ketamine anesthesia.

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  • Arterial blood samples were collected from mothers and umbilical cord vessels for blood-gas analysis.
  • Results were compared to a historical group that received thiopentone anesthesia.
  • Neonatal status was assessed using modified Apgar scores and time to sustained respiration (TSR).

    • Main Results:

    • Ketamine anesthesia resulted in significantly higher maternal and umbilical cord pH and base excess values compared to thiopentone.
    • The oxygen gradient across the umbilical cord (Uv-Ua PO2) was lower with ketamine.
    • Eight infants exhibited clinical depression, and the average TSR was 58.1 seconds.
    • Maternal side effects included hallucinations in 5 patients and unpleasant dreams in 5 instances.

    Conclusions:

    • Ketamine anesthesia appears unassociated with significant biochemical asphyxia in Cesarean sections.
    • Ketamine may contribute to drug-induced neonatal depression, warranting caution.
    • Re-evaluation of ketamine dosage for Cesarean sections is recommended, potentially using lower doses.