Abstract
The disposition of propofol was studied in women undergoing elective Caesarean section. Indices of maternal recovery and neonatal assessment were correlated with venous concentrations of propofol. After induction of anaesthesia with propofol 2.0 mg · kg−1, ten patients received propofol 6 mg · kg−1 · hr−1 with nitrous oxide 50 per cent in oxygen (low group) and nine were given propofol 9 mg · kg−1 · hr−1 with oxygen 100 per cent (high group). Pharmacokinetic variables were similar between the groups. The mean ± SD Vss = 2.38 ± 1.16 L · kg−1, Cl = 39.2 ± 9.75 ml · min−1kg−1 and t1/2β= 126 ± 68.7 min. At the time of delivery (8–16 min), the concentration of propofol ranged from 1.91–3.82 μg · ml−1 in the maternal vein (MV), 1.00–2.00 μg · ml−1 in the umbilical vein (UV) and 0.53–1.66 μg · ml−1 in the umbilical artery (UA). Neonates with high UV concentrations of propofol at delivery had lower neurologic and adaptive capacity scores 15 minutes later. The concentrations of propofol were similar between groups during the infusion but they declined at a faster rate in the low group postoperatively. Maternal recovery times did not depend on the total dose of propofol but the concentration of propofol at the time of eye opening was greater in the high group than the low group (1.74 ± 0.51 vs 1.24 ± 0.32 μg · m−1, P < 0.01). The rapid placental transfer of propofol during Caesarean section requires propofol infusions to be given cautiously, especially when induction to delivery times are long.
Résumé
Nous avons mesuré l’élimination du propofol lors de césariennes électives et avons mis en relation le réveil maternel et la performance du nouveauné avec la concentration veineuse de propofol. Après une dose d’induction de 2,0 mg · kg−1 de propofol, nous en perfusions 6 mg · kg−1 · h−1 de plus chez dix patientes qui respiraient 50 pour cent de protoxyde d’azote avec de l’oxygène (groupe 1) et 9 mg · kg−1 · h−1 chez neuf respirant de l’oxygène pur (groupe 2). Les variables pharmacocinétiques étaient semblables dans les deux groupes avec un Vss de 2,38 ±1,16 L · kg−1, une Cl de 39,2 ± 9,75 ml · mn−1 kg−1 et une t1/2β de 126 ± 68,7 mn. Au moment de la naissance (8–16 min post-induction), les concentrations de propofol allaient de 1,91 à 3,82 μg · ml−1 dans le sang veineux maternel, de 1,00 à 2,00 μg · ml−1 dans la veine ombilicale et de 0,53 à 1,66 μg · ml−1 dans l’artère ombilicale. Les nouveauxnés au sang veineux ombilical plus riche en propofol, avaient, 15 minutes après la naissance,un «neurologic and adaptative capacity score» plus bas. Semblables pendant la période de perfusion. les concentrations de propofol diminuèrent plus vite chez le groupe 1 après l’opération. La dose totale de propofol n’influençait pas le réveil des patientes mais, à l’ouverture des yeux, celles du groupe 2 en avaient des concentrations plus élevées: 1,74 ±0,51 vs 1,24 ± 0,32 μg · ml−1, P < 0,01. A cause d’un transfert placentaire rapide, on doit perfuser le propofol avec prudence lors d’une césarienne surtout si l’intervalle entre l’induction et la naissance se prolonge.
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Gin, T., Yau, G., Chan, K. et al. Disposition of propofol infusions for caesarean section. Can J Anaesth 38, 31–36 (1991). https://doi.org/10.1007/BF03009160
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DOI: https://doi.org/10.1007/BF03009160