Rocuronium versus suxamethonium for rapid sequence induction of general anaesthesia for caesarean section: influence on neonatal outcomes.

BACKGROUND: In a previous study we compared rocuronium and suxamethonium for rapid-sequence induction of general anaesthesia for caesarean section and found no difference in maternal outcome. There was however, a significant difference in Apgar scores. As this was a secondary outcome, we extended the study to explore this finding on a larger sample. METHODS: We included 488 parturients of whom 240 were women from the original study. Women were randomly assigned to receive either rocuronium 1mg/kg (ROC n=245) or suxamethonium 1mg/kg (SUX n=243) after propofol 2mg/kg. Anaesthesia was maintained with up to 50% nitrous oxide and up to one minimum alveolar concentration of sevoflurane until the umbilical cord was clamped. We compared neonatal outcome using Apgar scores and umbilical cord blood gases. RESULTS: Data were analysed for 525 newborns (ROC n=263vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores <7 at 1min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5min (ROC 8% vs. SUX 4.2%, P=0.1) or 10min (ROC 3.0% vs. SUX 1.9%, P=0.58). There was no difference between groups in other measured outcomes. CONCLUSION: The use of rocuronium was associated with lower Apgar scores at 1min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation.

[HELLP syndrome complicated by liver rupture - case report]. / HELLP syndrom komplikovaný rupturou jater - kazuistika.

OBJECTIVE: A case of HELLP syndrome complicated by liver rupture in the 36th week of pregnancy. DESIGNS: A case report. SETTING: Department of Obstetrics and Gynaecology, FN Olomouc. CASE REPORT: The authors report a case of 31 years old female patient who came to the hospital at 36th week of pregnancy with epigastric pain lasting about 14 days. The problems became worse in the last 10 hours. At admission, the patient was pale with repeatedly unmeasurable blood pressure, and she had lower limbs oedema. There was performed the caesarian section, during the operation the liver rupture was found. Both, patient and her baby, was saved thanks to the concerted interdisciplinary team work. CONCLUSION: One of the most serious complications of HELLP syndrome is liver rupture. It occurs in 3.8% of HELLP syndrome cases. The solution of this complication is to perform an acute operation. The operation is based on liver suture with application of deep mattress suture, applying hemostatic materials, liver compression by Mikulicz´s tamponade or ligation of liver artery. There is also possibility to use omentoplasty. If there is necessity of liver resection for necrotic focus, the argon coagulative laser is used preferably.