A Comparison of Propofol and Ketamine as Induction Agents for Cesarean Section
Ophas Wanna MD*, Thewarug Werawatganon MD**, Sonthaya Piriyakitphaiboon MD***, Busakorn Taesiri MD****
Affiliation : * Department of Anesthesiology, Sappasitthiprasong Ubonratchatani Hospital ** Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University *** Department of Obstetrics and Genecology, Sappasitthiprasong Ubonratchatani Hospital **** Department of Pediatrics, Sappasitthiprasong Ubonratchatani Hospital
Objective : To compare the neonatal and maternal effects of propofol and ketamine as induction agents for
elective cesarean section
Design : Randomized, double-blind study.
Setting : Inpatient Obstetrics Department of Sappasitthiprasong Ubonratchatani Hospital, Ubonratchatani
province, Thailand.
Intervention : 2 groups of 50 patients each receiving either 2mg/kg propofol or 1mg/kg ketamine for the
induction of anesthesia.
Results : The time from the induction to cord clamping (I-C), the time from the uterine incision to cord
clamping (U-C), the hemodynamic changes, sleep’ quality, dream, recall, awareness, Postoperative nausea
& vomiting (PONV), and Apgar scores were studied. In the ketamine group Systolic Blood Pressure and
Diastolic Blood Pressure rose about10-25% of the baseline after the induction, intubation, skin incision,
and cord clamping (p < 0.001) while in the propofol group only the Heart Rate rose (p < 0.036) after the
induction, the intubation, the skin incision, and cord clamping. Apgar scores, the I-C time, the U-C time, the
age, the weight and total amount of methergin and oxytocin were not significantly different in both groups.
No incidence of awareness, nightmare and ketamine’s phychomimetic side effects was found. The incidence of
unpleasant light sleep, dreams and PONV was low. Most patients were willing to have the same anesthetic
technique for the next cesarean section (81.3% of the propofol group& 86% of the ketamine group).
Conclusion : Both propofol and ketamine can be used as alternative induction agents to thiopental. The
addition of sevoflurane immediately after the induction, together with the use of midazolam and morphine
after delivery shall prevent awareness and ketamine’s phychomimetic side effects.However ketamine was
cheaper and although Systolic Blood Pressure and Diastolic Blood Pressure were elevated they were within
an acceptable range.
Keywords : Ketamine General anesthesia, Cesarean section, Low resource
