Comparison of different doses of Fentanyl for prevention of hemodynamic changes during induction and intubation in parturients undergoing caesarian section under general anesthesia.

Abstract

Present study was designed to find low, safe and efficacious dose of fentanyl to avoid its foetal side effects by comparing two doses of fentanyl to prevent haemodynamic hazards at induction and intubation in patients undergoing caesarean section (CS) under general anaesthesia (GA).Method: Forty five full term parturients posted for emergency/elective caesarean section under GA of ASA Grade I or II, age group between 18 to 35 years were randomly distributed into three groups. Intravenous fentanyl 0.5µg/kg or1µg/kg diluted to 5 ml or normal saline 5 ml was administered three minutes before induction in Group F 0.5, Group F1or Group C respectively. Maternal haemodynamic parameters and foetal parameters were recorded at different time intervals.Results: Group F and Group F1 showed significant reduction and stability in maternal haemodynamics when compared with the control group, but no statistical difference was observed amongst them. No difference was observed in foetal Apgar score and cord blood pH in all three groups. Conclusion:Fentanyl in doses as low as 0.5µg/kg can be used safely in parturients to prevent haemodynamic hazards at intubation in patients undergoing CS under GA.

Induction opioids for caesarean section under general anaesthesia: a systematic review and meta-analysis of randomised controlled trials

“…Our search yielded 17 studies for inclusion. [7][8][9][10][15][16][17][18][19][20][21][22][23][24][25][26][27] Of these there were 10 remifentanil, four alfentanil and three fentanyl studies. Overall, opioids appeared not to affect neonatal outcomes, with the exception of fentanyl which caused a significant reduction in fiveminute Apgar scores.…”

“…Overall, there was a significant reduction in maximum SBP (WMD -22.29 mmHg; 95%CI -27.96 to 16.61 mmHg; I 2 =73%; P<0.0001) [8][9][10][16][17][18]20,[22][23][24]26 , MAP (WMD -13.68 mmHg; 95%CI -19.00 to 8.36 mmHg; I 2 =69%; P<0.00001) 8,10,17,27 and HR (WMD -13.81 bpm; -16.92 to -10.70 bpm; I 2 =14%; P<0.00001) with opioids. [8][9][10]17,19,20,23,27 All three agents had a similar magnitude of effect on SBP, MAP and HR (P<0.001). Intra-operative maternal epinephrine concentrations were significantly reduced by remifentanil (WMD -122.56 pg/mL; 95%CI-206.20 to -38.93 pg/mL; I 2 =0%; P=0.0004) 18,22 but not alfentanil (WMD -29.11 pg/mL; 95%CI-127 to -69.43 pg/mL; I 2 =0%; P=0.56).…”

“…3). 7,9,[15][16][17][18][19][20][21][22][23][24] Of these 12 studies, six investigated the effect of remifentanil, 16,18,20,[22][23][24] three alfentanil 9,15,21 and three fentanyl. 7,17,19 When divided into the individual agents there was no significant difference after remifentanil (WMD -0.27; 95%CI -0.74 to 0.19; I 2 =78%; P=0.25), alfentanil (WMD 0.05; 95%CI -0.12 to 0.21; I 2 =0%; P=0.58) or fentanyl (WMD -0.02; 95%CI -0.30 to 0.26; I 2 =72%; P=0.89).…”

“…4). 7,9,[15][16][17][18][19][20][21][22][23][24] Fentanyl was the only opioid to show a significant reduction in Apgar scores (WMD -0.20; 95%C -0.33 to -0.08; I 2 =0%; P=0.002). There was no difference with remifentanil (WMD -0.19; 95%CI -0.40 to 0.02; I 2 =82%; P=0.08) or alfentanil (WMD 0.14; 95%CI -0.08 to 0.36; I 2 =73%; P=0.21).…”

“…10,22,25 Only one study mentioned NICU admission following alfentanil use and showed no difference (P=0.72). 9 Ten studies investigated umbilical artery pH 7,8,10,[15][16][17][18]20,22,25 and six studies investigated umbilical artery BE. 7,10,18,20,22,25 There was no significant difference in umbilical artery pH with remifentanil (WMD 0.01; 95%CI -0.00 to 0.02; I 2 =33%; P=0.14), alfentanil (WMD 0.02; -0.04 to 0.08; I 2 =0%; P=0.55) or fentanyl (WMD 0.00; 95%CI -0.01 to 0.01; I 2 = 22%; P=0.90).…”