Ketamine and Diazepam as Anaesthesia for Forceps Delivery. A Comparative Study

Abstract

In a clinically controlled trial in forceps delivery, a comparison was made between the general anaesthesia induced by ketamine and that by a combination of diazepam and N2O. Local anaesthesia was added in the diazepam group for episiotomy and suturation. The indication for operative delivery was in all cases a prolonged second stage of labour. In the katamine group, awareness was noted in four cases out of 13, even if the analgesic effect was found to be good. Four patients showed marked, short-lasting elevation of blood pressure and seven had unpleasant dreams. All thirteen mothers in the diazepam group found the anesthesia effective and the recovery pleasant. The blood pressure was stable. One mother in each group required ventilation with oxygen due to respiratory depression of short duration. Three of the children in the ketamine group and two in the diazepam group had subnormal Apgar score with slight acidosis. This was probably not attributable to the anaesthesia.

Transplacental passage of diazepam during labor: Influence of uterine contractions

“…An earlier report showed that the combined diazepam-N 2 0/0 2 anaesthesia was better accepted than ketamine by the mothers. 6 Although our results confirm this favorable impression, a proper evaluation of the method should take into account other alternatives and the conditions under which the anesthesia is to be used. Clin.…”

“…The obstetrician's impression of the anesthesia was also recorded. 6 The clinical state of the newborn was assessed by the Apgar scoring system at I and 5 min after deli very and thereafter observed closely. The pH, pC0 2 , and base excess (BE) were determined in mixed arteriovenous umbilical cord blood as an indication of the degree of acidosis.…”

“…Other medications were given at the same time to a larger number of patients in Group II than in Group I. The Apgar score was subnormal (6 or less) in 2 infants in Group I Placental transfer of diazepam in labor 595…”

“…17,19,23 However, with a drug like DZ which is used to relieve anxiety or to induce sleep as well as to contribute to the analgesia during labor, the rate of the transfer to the fetus is also of considerable practical interest. 3,6,8,19 The difficulty in obtaining a sufficient number of relevant blood samples from mother and newborn is the main reason for the paucity of information on the rate of transplacental passage of drugs in man and the time necessary to achieve distribution equilibrium between the maternal circulation and the fetal unit. 14,15 The concentration of the drug in the readily avail- x I x 6…”

Diazepam as an Induction Agent for Caesarean Section: A Clinical and Pharmacokinetic Study of Fetal Drug Exposure

“…The newborn infants were kept under observation by a paediatrician during the hospital stay which lasted for at least one week. On the day after delivery, the mothers were asked for their opinion on the efficacy and the pleasantness of the anaesthesia (Ellingson et al, 1977).…”