A number of studies have described the use during cesarean section of propofol, a hypnotic agent used for the IV induction and maintenance of anesthesia (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19 and 20). Apparently, the drug has not been used during the 1st and 2nd trimesters in humans. Reproduction studies in rats and rabbits at doses 6 times the recommended human induction dose revealed no evidence of impaired fertility or fetal harm (21).
The pharmacokinetics of propofol in women undergoing cesarean section was reported in 1990 (1). Propofol rapidly crosses the placenta and distributes in the fetus (2,3,4,5,6,7,8,9,10,11 and 12). The fetal:maternal (umbilical vein:maternal vein) ratio is approximately 0.7. Doses were administered either by IV bolus, by continuous infusion, or by both methods.
Several studies have examined the effect of maternal propofol anesthesia on infant Apgar scores, time to sustained spontaneous respiration, and Neurologic and Adaptative Capacity Score (NACS) or Early Neonatal Neurobehavioural Scale (ENNS) (1,2,4,5,7,8,11,12,13,14,15,16,17 and 18). Most investigators reported no difference in the Apgar scores of infants exposed to propofol either alone or when compared with other general anesthesia techniques, such as thiopental with enflurane or isoflurane (2,5,7,8,14,15,16,17 and 18). Moreover, no correlation was found between the Apgar scores and umbilical arterial or venous concentration of propofol (2,5,8,11,15).
