A Comparative Study Of The Haemodynamic Effects Of Thiopentone And Propofol Used As Intravenous Induction Agents For Caesarean Section In Pre-eclampsia/eclampsia Mothers
A prospective study comparing the haemodynamic effect of Thiopentone and Propofol for induction of anaesthesia for caesarean section for 90 pre-eclamptic/ eclamptic mothers was carried out at Kenyatta National Hospital maternity theater. Randomly allocated, Thiopentone and Propofol III the standard induction dosage of 4mg/kg and 2mg/kg respectively was used on 90 pre-eclamptic/ eclamptic patients undergoing caesarean section. The 2 groups were comparable in age, parity and distribution. Systolic, mean and diastolic arterial pressure and heart rate were recorded non-invasively, on arrival at the theater, following intubation, prior to, during and post-induction of anaesthesia, at 2minutes, 4minutes, at delivery of baby and 5 minutes after delivery. The study found that the heart rate increased from 125 beats/min to 138beats/min (13beats/min increase) following induction and intubation with Thiopentone, and remained elevated by 7 beats/min up to 5 minutes post-delivery of the baby. However, following induction and intubation with Propofol, the Heart rate increased from 123- beats/min t0129 beats/min (6beats/min increase) and returned to baseline values by Sminutes post-delivery of the baby. The difference in rise in the heart rate between the two drugs was statistically significant (p-value< 0.05) There was a significant increase in systolic blood pressure in the Thiopentone group from 155mmHg to 168mmHg (13mmHg increase) post- induction, whereas in the Propofol group the post-induction systolic blood pressure was same as baseline values of 152mmHg(OmmHgincrease). (P value <0.05).The only rise in systolic blood pressure in the Propofol group was during induction, 9mmHg, but this was not statistically significant compared with the rise in Thiopentone group of 5mmHg. There was a significant increase in the diastolic blood pressure from 108mmHg to 114mmHg(6mmHg raise) post-induction in the Thiopentone group compared to the fall in the Propofol group from 106mmHgto 103mmHg(3mmHg fall) (p-value <0.05).In the two groups the diastolic blood pressure consistently fell up to 86-87mmHg at 5 minutes post delivery of the baby. The mean arterial pressure rose from 123mmHg to 134mmHg (llmmHg increase) in the Thiopentone group post-induction whereas it only rose by 1mmHg (from 120mmHg to 121mmHg) in the Propofol group. This was significant (p-value <0.05). It then consistently fell in both groups to l05mmHg by Sminutes post delivery of the baby. During induction, the rise in all the parameters was minimal and was statistically insignificant. The median age of the 90 patients studied was 2S years with the minimum age being 14 years and the maximum age 38 years. The mode was 20 years. The mean age being 2S.367years. The median Parity was 0 with the minimum parity being nullipara and the maximum Parity being S.000. The mode was Para O. There was a hypertensive response to intubation in the Thiopentone group which was absent in the Propofol group and a greater rise in heart-rate post-intubation with thiopentone as compared to Propofol. The investigation thus found Propofol to cause less variation in arterial pressure and heart-rate than Thiopentone in Pre-eclamptic/ eclamptic mothers. Pre- eclampsia! eclampsia, was found to be a disease occurring predominantly in young nulliparas.
CitationMaster Of Medicine In Anaesthesia Of The University Of Nairobi, 2001
University of NairobiFaculty of Medicine