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Effect of rapid sequence induction for caesarean section in general anaesthesia with rocuronium versus succinylcholine on neonatal outcome: prospective randomised interventional multicentric trial


Kosinova, M.1; Stourac, P.1; Seidlova, D.2; Adamus, M.3; Krikava, I.1; Pavlik, T.4 RocSugIO Study Group (

European Journal of Anaesthesiology (EJA): June 2014 - Volume 31 - Issue - p 190
Obstetric Anaesthesia

1University Hospital Brno, Medical Faculty of Masaryk University, Dept of Anaesthesiology & Intensive Care, Brno, Czech Republic, 2University Hospital Brno, 2nd Anaesthesiological Department, Brno, Czech Republic, 3University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Dept of Anaesthesiology & Intensive Care, Olomouc, Czech Republic, 4Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic

Background and Goal of Study: Rocuronium for Rapid Sequence Induction (RSI) for Caesarean Section (CS) in General Anaesthesia (GA) can be an alternative to succinylcholine as neuromuscular-blocking agent. The aim of this study was to examine whether there are any differences in neonatal outcome when comparing the above mentioned relaxants.

Materials and methods: With Ethical Committee approval we enrolled 237 parturients who underwent CS in GA in the period 12/2012-11/2013. RSI for GA was performed with propofol 2 mg kg-1 and rocuronium 1 mg kg-1 in ROC group or succinylcholine 1 mg kg-1 in SUC group after stratified randomization. Until umbilical cord was clamped, we used up to 50% concentration of nitrous oxide and sevoflurane up to 1 MAC for anaesthesia maintenance. We recorded maternal and newborn characteristics data, neonatal outcome parameters (pH, pCO2, pO2 and BE in arterial umbilical blood, APGAR score) and transparency of amniotic fluid. Both groups were reported descriptively (mean, median, standard deviation); all differences were tested using Mann-Whitney test at the 5% significance level (SPSS 21).

Results and discussion: During the study period we enrolled 117 parturients and 128 newborns into ROC group and 120 parturients and 127 newborns into SUC group. We didn't reported statistically significant differences in monitored parameters between both groups, except the lower weight of the newborns (ROC 2852, 2990, ±828.9 g; SUC 3082, 3125, ±740.8 g, p= 0.049) what can explain significantly lower APGAR score in 1st (ROC 7.8, 9, ±2.5; SUC 8.5, 9, ±1.7; p=0.049), 5th (ROC 8.6, 9, ±1.8; SUC 9.2, 10, ±1.3; p=0.012) and 10th minute (ROC 9.1, 10, ±1.5; SUC 9.6, 10, ±1.1; p=0.004) in ROC group which is however not clinically significant APGAR in 10th minute 7 and more (ROC 94.5%; SUC 99.2%; p=0.066). We neither recorded any significant difference in values of pH (ROC 7.3, 7.3, ±0.1; SUC 7.3, 7.3, ±0.1; p=0.428), pCO2 (ROC 6.9, 6.9, ±1.1; SUC 6.7, 6.8, ±1.0; p=0.077), pO2 (ROC 4.0, 3.5, ±2.5; SUC 3.8, 3.4, ±2.1; p=0.803) and BE (ROC -3.4, -3.0, ±3.3; SUC -3.7, -3.4, ±2.7; p=0.505).

Conclusion: We conclude no clinical difference between both groups. This is supported with no difference and good clinical values in acid base balance of arterial umbilical blood.

Acknowledgements: Financial support: Czech Ministry of Health: Internal Grant Agency (ID: NT 13906-4/2012). ID: NCT01718236

© 2014 European Society of Anaesthesiology