Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol
Doebeli et al. 2013. Theriogenology 80: 850–854
What did the research find?
Both alfaxalone and propofol can safely be used for induction of anaesthesia in bitches undergoing Caesarean sections. Puppy survival up to 3 months after birth was similar between drugs, however alfaxalone was associated with better neonatal vitality (quantified by Apgar scores) during the first 60minutes after delivery.
How was it conducted?
The study examined 22 litters, with bitches aged 1-11yrs and bodyweights ranging from 1.6-51kg. These were split into 2 groups, each with a variety of breed sizes. Caesarean section was indicated due to dystocia in all cases.
All bitches received intravenous fluid therapy (IVFT) with an isotonic crystalloid upon presentation. In cases of poor general condition, or severe dehydration intravenous colloid solutions were also utilised (or HAES-steril 10% if clinically appropriate). Patients were preoxygenated for 5minutes prior to induction using flow-by oxygen at 2L/minute. Sedatives and analgesia were not administered until all puppies were delivered. For induction bitches were randomly assigned to receive alfaxalone 1-2mg/kg or propofol 2-6mg/kg; both drugs were administered intravenously to allow endotracheal intubation. Anaesthesia was maintained using isoflurane in oxygen dosed to effect. Immediately after delivery of the last puppy, fentanyl was given via continuous rate infusion 5mcg/kg BW/h which was stopped at the end of surgery. All bitches received intravenous buprenorphine and carprofen 20minutes before the end of surgery.
Immediately after delivery, puppies had fluid cleared from upper airways using suctioning and were rubbed/blow dried on warm bedding. All puppies were oxygenated using flow-by oxygen at 2L/minute. In the absence of spontaneous breathing, clinically appropriate interventions were made (gentle nose to mouth breathing, respiratory stimulant drops and a single subcutaneous bolus of warmed glucose 5%). Resuscitation was attempted for at least 30minutes if a heartbeat was detected. Each puppy was weighed and clinically examined; once stabilised puppies were transferred to a newborn incubator.
A modified Apgar scoring system (as described by Veronesi et al. 2009) was used to objectively assess neonatal vitality. Heart rate, respiratory effort (respiratory rate and type of crying), reflex irritability, motility and mucous membrane colour were the parameters measured. Each parameter was rated from 0 (absent) to 2 (detectable, strong). The sum of all parameters provided the total Apgar score. Puppies were assessed at 5, 15 and 60minutes after delivery.
Results
Pre- and intra-operative parameters did not differ between the groups. Total litter size ranged from 1-10 puppies; a median of 3 puppies was delivered by Caesarean section, with no differences observed between the groups. Birth weights ranged from 71-524g and were considered to be within the normal range for each breed.
Maternal recovery was similar for both groups. Neither the number of puppies delivered nor the proportion of surviving puppies at various time intervals from 60mins to 3months after delivery differed between groups.
Anaesthetic induction drug used, and time of scoring were associated (P<0.001) with the Apgar score but delivery time was not. Apgar score increased in both groups from 5 to 60minutes after delivery. Apgar scores in the alfaxalone group were greater than, and significantly different, to those in the propofol group at 5, 15 and 60minutes after delivery; the overall estimated score difference between the groups was 3.3 (95% confidence interval: 1.6-4.9; P<0.001).
Why is this important?
Use of the Apgar scoring system allowed for objective comparison between anaesthetic drugs. Apgar scoring has been deemed to be a reliable way of assessing new-born puppies to determine viability and survival prognosis (Veronesi et al, 2009).
It is well recognised that the most critical moments in a puppy’s life are the time interval between delivery and first breath, and time of first contact with and acceptance by the dam. The neonate’s ability to breathe and the dam’s ability to take care of her offspring are significantly influenced by the anaesthetic protocol chosen to perform a C-section (Claude and Meyer, 2016).
As such, the study indicates that alfaxalone should be considered as the induction drug of choice for performing Caesarean sections. It achieved higher Apgar scoring than propofol at the most critical time period following a C-section, indicating a significant clinical advantage.
Originally published: Wednesday, 9th June 2021
Last updated: Thursday, 10th June 2021
References
Veronesi M.C., Panzani S., Faustini M., Rota, A. 2009. An Apgar scoring system for routine assessment of newborn puppy viability and short-term survival prognosis. Theriogenology. 72(3): 401-407.
Claude A., Meyer R.E. 2016. Anaesthesia for caesarean section and for the pregnant patient. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia, 3rd ed. 366-375. BSAVA, Gloucester, UK.
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