Rocuronium; Suxamethonium; Caesarean section; Neonatal outcome; Apgar score

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 1 mg/kg (ROC n=245) or suxamethonium 1 mg/kg (SUX n=243) after propofol 2 mg/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=263 vs. SUX n=262). There was a statistically significant difference in the proportion of Apgar scores < 7 at 1 min (ROC 17.5% vs. SUX 10.3%, P=0.023) but no difference at 5 min (ROC 8% vs. SUX 4.2%, P=0.1) or 10 min (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 1 min compared with suxamethonium. The clinical significance of this is unclear and warrants further investigation. (C) 2017 Elsevier Ltd. All rights reserved.