Canadian Anaesthetists’ Society Journal

, Volume 24, Issue 5, pp 586–596 | Cite as

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

  • Richard J. Palahniuk
  • John Scatliff
  • Diane Biehl
  • Henry Wiebe
  • K. Sankaran


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.


Caesarean Section Nitrous Oxide Apgar Score Methoxyflurane Elective Caesarean Section 
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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.


  1. 1.
    Cosmi, E.V. &Marx, G.F. Acid-base status of the fetus and clinical condition of the newborn following Cesarean section. Am. J. Obstet. Gynecol.102: 378 (1968).PubMedGoogle Scholar
  2. 2.
    Benson, R.C., Berendes, H., &Weiss, J. Fetal compromise during elective Cesarean section. Am. J. Obstet. Gynecol.103: 570 (1969).Google Scholar
  3. 3.
    Shnider, S.M. Anesthesia for elective Cesarean section, Obstetrical Anesthesia. Edited by S.M. Shnider. Baltimore, Williams and Wilkins. pp. 94–105 (1970).Google Scholar
  4. 4.
    Fothercill, R.J., Robertson, A., &Bond, R.A. Neonatal acidaemia related to procrastination at Caesarean section. J. Obstet. Gynaecol. Br. Comm.78: 1010 (1971).Google Scholar
  5. 5.
    Teramo, K. Foetal acid-base values during Caesarean section. Lancet2: 1146 (1968).PubMedCrossRefGoogle Scholar
  6. 6.
    Crawford, J.S. Awareness during operative obstetrics under general anaesthesia. Br. J. Anaesth.43: 179 (1971).PubMedCrossRefGoogle Scholar
  7. 7.
    Marx, G.F. &Mateo, C.V. Effects of different oxygen concentrations during general anaesthesia for elective Caesarean section. Canad. Anaesth. Soc. J.18: 587 (1971).PubMedCrossRefGoogle Scholar
  8. 8.
    Khazin, A.F., Hon, E.H., &Hehre, F.W. Effects of maternal hyperoxia on the fetus. I. Oxygen tension. Am. J. Obstet. Gynecol.109: 628 (1971).PubMedGoogle Scholar
  9. 9.
    Crawford, J.S., Burton, M., &Davies, P. Anaesthesia for section: further refinements of a technique. Br. J. Anaesth.45: 726 (1973).PubMedCrossRefGoogle Scholar
  10. 10.
    Heese, H. deV., Davey, D.A., Rorke, M., &Molteno, C. Effect of maternal anaesthesia on oxygenation and acid-base status of the newborn infant. South African Medical Journal47: 1991 (1973).PubMedGoogle Scholar
  11. 11.
    Moir, D.D. Anaesthesia for Caesarean section: An evaluation of a method using low concentrations of halothane and 50 per cent oxygen. Br. J. Anaesth.42: 136 (1970).PubMedCrossRefGoogle Scholar
  12. 12.
    Latto, L.P. &Wainwright, A.C. Anaesthesia for Caesarean section analysis of blood concentrations of methoxyflurane using 0.1 per cent methoxyflurane and 40 per cent oxygen. Br. J. Anaesth.44: 1050 (1972).PubMedCrossRefGoogle Scholar
  13. 13.
    Scanlon, J.W., Brown, W.U.Jr.,Weiss, J.B., &Alper, M.H. Neurobehavioural responses of newborn infants after maternal epidural anesthesia. Anesthesiology40: 121 (1974).PubMedCrossRefGoogle Scholar
  14. 14.
    Moreau, T. &Birch, H.G. Relationship between obstetrical general anaesthesia and rate of neonatal habituation to repeated stimulation. Dev. Med. Child. Neurol.16: 612 (1974).PubMedCrossRefGoogle Scholar
  15. 15.
    Brackbill, Y., Kane, J., &Manniello, R.L. Obstetric premedication and infant outcome. Am. J. Obstet. Gynecol.118: 377 (1974).PubMedGoogle Scholar
  16. 16.
    Fry, B.W. &Taves, D.R. Serum fluoride analysis with the fluoride electrode. J. Lab. Clin. Med.75: 1020 (1970).PubMedGoogle Scholar
  17. 17.
    Durowitz, V. Neurologic fragility in the newborn: influence of medication in labour. Br. J. Anaesth.47: 1005 (1975).CrossRefGoogle Scholar
  18. 18.
    Cousins, M.J. &Mazze, R.I. Methoxyflurane nephrotoxicity: a study of dose response in man. J.A.M.A.225: 1611 (1973).PubMedCrossRefGoogle Scholar
  19. 19.
    Scanlon, J.W., Ostheimer, G.W., Lurie, A.O., Brown, W.U., Weiss, J.B., &Alper, M.H. Neurobehavioural responses and drug concentrations in newborns after maternal epidural ane: thesia with bupivacaine. Anesthesiology45: 400 (1976).PubMedCrossRefGoogle Scholar
  20. 20.
    Morishima, H.O., Daniel, S.S., &Richards, R.T. The effect of increased maternal Pao2 upon the fetus during labor. Am. J. Obstet. Gynecol.123: 257 (1975).PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1977

Authors and Affiliations

  • Richard J. Palahniuk
    • 1
  • John Scatliff
    • 1
  • Diane Biehl
    • 1
  • Henry Wiebe
    • 1
  • K. Sankaran
    • 1
  1. 1.Departments of Anaesthesia and PaediatricsUniversity of Manitoba and Health Sciences CentreWinnipegCanada

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