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Maternal and neonatal effects of methoxyflurane, nitrous oxide and lumbar epidural anaesthesia for caesarean section

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Summary

General anaesthetic techniques continue to be used for Caesarean section despite the possible increased incidence of foetal acidosis and neonatal depression. Two techniques of general anaesthesia ( methoxyflurane-oxygen and nitrous oxideoxygen) and lumbar epidural anaesthesia were compared in 37 patients undergoing elective Caesarean section. Apgar scores at birth were similar in all three groups. Neurophysiological testing of the neonates at six hours and twenty-four hours of age revealed a superiority for the methoxyflurane-oxygen and lumbar epidural techniques, although the babies in the epidural group tended to be hypotonic. Cord blood gas analysis showed the babies in the methoxyflurane group to have a higher Pao2 with less metabolic acidosis than the babies from the other two groups. The maternal effects of the three anaesthetic techniques were similar, with only a small rise in serum fluoride levels noted in the methoxyflurane group.

Résumé

Ľanesthésie generale est encore ďusage courant pour les cas de césariennes malgré une incidence plus fréquente ďacidose foetale et la possibilité de dépression du nouveau-né. Deux techniques ďanesthésie générale, le methoxyfluraneoxygène et la protoxyde ďazote-oxygène, ainsi qu’une technique ďanesthésie régionale, soit ľépidurale lombaire continue, ont été étudiées et comparées au cours de 37 cas de césariennes.

Les résultats du score Apgar ont été semblables avec les trois méthodes. Ľévaluation neuro-physiologique des nouveau-nés 6 heures et 24 heures après la naissance montrait la supériorité de ľanesthésie au methoxyflurane-oxygène et de ľépidurale sur la troisième technique; les bébés du groupe de ľépidurale avaient, en général, tendance à être hypotoniques.

Les gazométries effectuées sur le sang du cordon ombilical montraient une Po2 plus élevée et moins ďacidose métabolique après une anesthésie au methoxyflurane-oxygène qu’avec les deux autres méthodes. Du côté maternel, les effets étaient à peu près semblables sauf pour une petite élévation des fluorures sériques dans le groupe anesthésie au methoxyflurane.

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Correspondence to Richard J. Palahniuk or John Scatliff or Diane Biehl or Henry Wiebe or K. Sankaran.

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Palahniuk, R.J., Scatliff, J., Biehl, D. et al. Maternal and neonatal effects of methoxyflurane, nitrous oxide and lumbar epidural anaesthesia for caesarean section. Can. Anaesth. Soc. J. 24, 586–596 (1977). https://doi.org/10.1007/BF03005532

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Keywords

  • Caesarean Section
  • Nitrous Oxide
  • Apgar Score
  • Methoxyflurane
  • Elective Caesarean Section