ORIGINAL ARTICLERemifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial
Introduction
Regional anesthesia is preferred for cesarean section because of reduced maternal mortality.1 However, general anesthesia may be indicated if regional anesthesia fails or is contraindicated, or for emergency delivery. In a recent meta-analysis, general anesthesia was shown to be associated with transient neonatal sedation and essentially benign effects on neonatal acid-base balance.2
The neuroendocrine stress response to surgery appears less well controlled with general than with regional anesthesia.3 The use of systemic opioids obtunds the hormonal stress response during lower abdominal procedures under general anesthesia.4 However, during cesarean section opioid administration is usually avoided until after delivery to reduce the risk of neonatal depression.[5], [6] If opioid administration before delivery is thought to be advantageous, remifentanil with its fast onset and rapid metabolism appears to be a suitable agent. It provides hemodynamic stability in patients undergoing cesarean section under general anesthesia,7 and has been successfully used in cases of maternal cardiac disease,[8], [9] neurological conditions, preeclampsia and liver disease.[10], [11], [12] However, previous studies showed that the use of remifentanil to control the hemodynamic response to intubation and surgery is associated with transitory but significant neonatal depression.[7], [13] Since this effect could be dose-dependent,14 the aim of our study was to investigate whether administration of low-dose remifentanil could control the neuroendocrine response at cesarean section under general anesthesia without adverse effect on the neonate.
Section snippets
Methods
The study was designed as a randomized, controlled, single-blind trial. Anesthetists and pediatricians were not blinded to anesthetic technique. Approval from the local research ethics committee was obtained and written informed consent was given by all patients who participated in the study.
Forty-two ASA I-II women with singleton term pregnancy scheduled for elective cesarean section were enrolled. All patients had absolute or relative contraindications to regional anesthesia. Exclusion
Results
Forty-two women were recruited to and completed the study. Maternal height, weight, gestational age, and neonatal weight were similar in the two groups (Table 1). Indications for general anesthesia are also presented in Table 1.
There were no significant differences between the groups in heart rate or blood pressure at any time (Figure 1, Figure 2).
Maternal hormone concentrations for the three sampling times are given in Table 2. Norepinephrine (P <0.001 in group C and P <0.0001 in group R) and
Discussion
Remifentanil, administered as a 0.5-μg/kg bolus before induction followed by an infusion of 0.15 μg·kg−1min−1 until peritoneal incision, partially obtunded the neuroendocrine response to surgery with a decrease in ACTH rise. However, this was at the expense of transient neonatal depression, with Apgar scores significantly lower in babies whose mothers had received remifentanil, although all scores improved to ⩾8 within 5 min. Neonatal respiratory depression has previously been reported
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2020, Anesthesie et ReanimationInduction opioids for caesarean section under general anaesthesia: a systematic review and meta-analysis of randomised controlled trials
2019, International Journal of Obstetric AnesthesiaCitation Excerpt :Six remifentanil studies investigated the requirement for post-delivery BVM and showed no difference (RR 1.45; 95%CI 0.88 to 2.39; I2=0%; P=0.71).10,16,20,22,25,26 Similarly there was no significant difference in neonatal intubation rate with remifentanil (RR 1.34; 95%CI 0.67 to 2.68; I2=0%; P=0.97)10,16,18,20,22,25,26 or alfentanil (RR 1.65; 95%CI 0.60 to 4.56; I2=0%; P=0.69).9,15 There was no increase in NICU admission with remifentanil (RR 0.95; 95%CI 0.77 to 1.19; I2=0%; P=0.67).10,22,25
Propofol in combination with remifentanil for cesarean section: Placental transfer and effect on mothers and newborns at different induction to delivery intervals
2017, Taiwanese Journal of Obstetrics and GynecologyOpioids given before cord clamping for cesarean delivery under general anesthesia
2016, International Journal of Obstetric AnesthesiaOpioids should be given before cord clamping for caesarean delivery under general anaesthesia
2016, International Journal of Obstetric Anesthesia