We investigated the neuromuscular effects and conditions of tracheal intubation after administration of rocuronium in 40 parturients undergoing elective cesarean section. After preoxygenation, anesthesia was induced in 20 patients by thiopental 4 mg/kg and, in the other 20 patients, by ketamine 1.5 mg/kg. Rocuronium 0.6 mg/kg was then administered, and neuromuscular transmission was assessed using electromyographic response to train-of-four stimulation of the ulnar nerve at the wrist every 10 s. The time to T1/control ratio of 50% neuromuscular block (NMB) as well as the time to maximum NMB (onset time) were compared in the two groups. The time to 50% block was 45 +/- 10 s in the thiopental group and 42 +/- 14 s in the ketamine group, while the onset time was 105 +/- 35 s in the thiopental group and 101 +/- 35 s in the ketamine group. Neither the time to 50% NMB nor the onset time were significantly different between the two groups. Tracheal intubation at 50% NMB was easily performed in all patients in the ketamine-rocuronium group but was difficult in 75% of the thiopental-rocuronium group. We concluded that ketamine 1.5 mg/kg followed by rocuronium 0.6 mg/kg may be suitable for rapid-sequence induction of anesthesia in parturients undergoing cesarean section.

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Supplementation of general anaesthesia with tramadol or fentanyl in parturients undergoing elective Caesarean sectionPurpose: Tramadol has been recommended for analgesia in parturients undergoing vaginal delivery. The present report investigated the effect of tramadol versus fentanyl on umbilical vein (UV) blood gases and Apgar scores of neonates delivered via elective Caesarean section under general anaesthesia. Methods: Forty ASA I or II parturients undergoing elective Caesarean section were included in a randomized double-blinded study. The patients were divided into a tramadol (n = 20) and fentanyl groups (n =.20). During preoxygenation, one group received 100 mg tramadol iv, while the second received 100 ~g fentanyl. Anaesthesia was induced in both groups by 3 mg'kg -t thiopentone and 1.5 mg.kg -t succinylcholine was given to facilitate tracheal intubation. Anaesthesia was maintained during the induction-delivery period with nitrous oxide 50% in oxygen. Results: The umbilical vein P02 was higher in the fentanyl (34 _ 5 mmHg) than in the tr-amadol group (24 _+ 6 mmHg) (P < 0.01 ), while the UV PC02 was higher in the tramadol group (50 -5 vs 45 _+ 4 mmHg) (P < 0.0 I). The Apgar scores at one and five minutes were not different between the two groups. Post operatively, two patients in the tramadol group recalled the crying of their newborn at delivery. Conclusion: Tramadol is associated with a high incidence of intraoperative maternal recall and can result in lower umbilical vein P02 and higher PC02 than in the fentanyl group.Objectif : Le tramadol a 6t6 recommand4 pour I'analg&ie des parturientes lots d'un accouchement par voie vaginale. La pr&ente &ude a explor6 I'effet du tramadol versus celui du fentanyl sur les gaz veineux ombilicaux et sur les indices d'Apgar des nouveau-n& lots d'une c6sarienne sous anesth6sie g6n&ale. M&hodes : Quarante parturientes ASA I ou II subissant une c&arienne 61ective ont particip~ ~ I'&ude randomis~e en double aveugle. Les patientes ont 6t4 r6parties en deux groupes, celui du tramadol (n = 20) et celui du fentanyl (n = 20 ). Pendant la pr6oxyg4nation, un groupe a re~u 100 mg de tramadol IV, pendant que le second a re~u 100/.tg de fentanyl. I'anesth&ie a 6t6 induite dans les deux groupes par 3 mgkg -~ de thiopental et 1,5 mg'kg -t de succinylcholine a 6t6 administr6 pour faciliter I'intubation endotrach6ale. I'anesth&ie a &6 maintenue pendant la p&iode induction-accouchement avec 50 % de protoxyde d'azote et d'oxyg~ne. R~sultats : La P02 de la veine ombilicale &ait plus 61ev& avec le fentanyl (34 + 5 mmHg) qu'avec le tramadol (24 _+ 6 mmHg) (P < 0.01 ), tandis que la PC02 de la veine ombilicale &ait plus 61ev6e avec le tramadol (50 -5 vs 45 + 4 mmHg) (P < 0.0 I). Les indices d'Apgar ~ une et cinq minutes n'&aient pas diff&ents clans les deux groupes. ~, la suite de I'intervention, deux patientes du groupe tramadol ont d&lar6 avoir entendu le cri de leur b6b6 ~ la naissance. Conclusion : Uusage du tramadol, compar6 ~ celui du fentanyl, est associ6 ~ une plus grande incidence de...