Rocuronium Versus Suxamethonium for Rapid Sequence Induction of General Anaesthesia for Caesarean Section: Influence on Neonatal Outcomes

Int J Obstet Anesth. 2017 Nov;32:4-10. doi: 10.1016/j.ijoa.2017.05.001. Epub 2017 May 10.


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.

Keywords: Apgar score; Caesarean section; Neonatal outcome; Rocuronium; Suxamethonium.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Androstanols / pharmacology*
  • Anesthesia, General / methods*
  • Anesthesia, Obstetrical / methods*
  • Apgar Score*
  • Cesarean Section
  • Female
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Rocuronium
  • Succinylcholine / pharmacology*


  • Androstanols
  • Succinylcholine
  • Rocuronium