A Clincal Study on Anesthetic Induction with a Thiopental and Ketamine Combination during C-Section / 대한마취과학회지

ABSTRACT

The incidence of C-sections has increased up to 15~20% and general anesthesia of C-sections is usually induced with thiopental or ketamin. Thiopental can produce significant fetal depression in doses higher than 4mg/kg and ketamine can cause dysphoria. The purpose of this study was to evaluate the possibility of minimizing untoward effects of both drugs by combination of the two. Sixty four pregnant women who underwent general anesthesia and C-section received thiopental 5 mg/kg(n=24); ketamine 1mg/kg(n=19); or a combination of thiopental 2.5mg/kg and ketamine 0.5mg/kg(n=21). The results were as follows 1. At endotracheal intubation, mean arterial pressure, pulse rate, systolic blood pressure, and rate pressure product were increased from the values before anesthetic induction but there was no statistical significance among groups(p>0.05). 2. The patient's movement to the strong stimulus of skin incision and intraoperative awareness were lower in the ketamine group and higher in the combined group. 3. The induction delivery interval and uterine incision delivery interval did not differ significantly among groups. 4. The incidence of 1 and 5 min Apgar scores below 7 was highest in the thiopental group and lowest in the ketamine group. 5. Postoperative recalling of intraoperative awareness occurred in two patients only in the combined group. 6. PAR scores in the recovery room did not differ significantly among 3 groups. From the above results, the combination of thiopental and ketamine appeared to offer little advantage over thiopental or ketamine. ketamine(1mg/kg) was though to be appropriate for the induction of anesthesia for C-section with respect to the incidence of intraoperative awareness, patient's movemnet to surgical stimuli, and neonatal Apgar scores.