Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial

Abstract

BackgroundRemifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn.MethodsUsing a double-blinded randomized design, a total of 151 parturients undergoing caesarean delivery under general anaesthesia were randomized into two groups – 76 patients received a bolus of remifentanil prior to induction, while 75 patients were assigned to the control group. Remifentanil 1 μg/kg was administered 30 seconds before the standard induction of general anaesthesia. The primary outcome measure was an assessment of neonatal adaptation using the Apgar score, while secondary outcomes included the need for respiratory support after delivery and differences in umbilical blood gas analysis (Astrup).ResultsThe incidence of lower Apgar scores between 0 and 7 was significantly higher in the remifentanil group at one minute (25% vs. 9.3% of newborns, p = 0.017); whilst at five minutes and later no Apgar score differences were observed. There was no difference in the need for moderate (nasal CPAP) or intensive (intubation) respiratory support, but significantly more neonates in the remifentanil group required tactile stimulation for breathing support (21% vs. 7% of newborns, p = 0.017). There was no difference in the parameters from umbilical cord blood gas analysis between the groups.ConclusionAt a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short.Trial registrationClinicalTrials.gov: NCT01550640.

Continuous intravenous infusion of remifentanil improves the experience of parturient undergoing repeated cesarean section under epidural anesthesia, a prospective, randomized study

“…Noskova et al [17] reported that a bolus of 1 μg/kg remifentanil before induction of general anesthesia decreased Apgar scores at 1 min after cesarean delivery, although the clinical symptoms were short. These observations were not found in the current study, because the dosage of remifentanil injection was lower than in the prior studies [17,18] .In this study, four neonates were needed resuscitation. In parturients with remifentanil, the reasons of resuscitation were umbilical cord around neck and the long delivery time of the fetus (from skin cutting to fetal delivery).…”

“…Many studies have shown that remifentanil (an off label drug for parturient) has less adverse neonatal or maternal effects during cesarean section; thus, they have suggested its use as a replacement for standard opioids in cesarean section [8][9][10] . In our clinic, we found that continuous intravenous infusion of low-dose remifentanil has a good rescue analgesic effect on incomplete epidural analgesia and provides a degree of sedation during cesarean section, which improves the patient experience.…”

Remifentanil up2date – Teil 2

“…Zur Sectio caesarea wurde eine erhöhte Inzidenz für eine neonatale Atemdepression festgestellt, wenn Remifentanil (1 µg/kg) vor Beginn der Operation appliziert wurde [17]. Eine Metaanalyse von 5 Publikationen kam zu dem Schluss, dass anhand der vorliegenden Daten und der Power der Studien keine gültige Aussage zur Sicherheit von Remifentanil zur anästhesiologischen Einleitung einer Sectio caesarea getroffen werden kann [18].…”

Comparison of Hemodynamic Changes Due to Endotracheal Intubation With Labetalol and Remifentanil in Severe Preeclamptic Patients Undergoing Cesarean Delivery With General Anesthesia

“…Therefore, the precise control of stress replication is necessary during the inspiration of anesthesia in preeclamptic patients. Various pharmacologic attempts have so far been made to suppress these pressor responses like opioids, lidocaine, along with α and β adrenergic blockers (8)(9)(10)(11)(12)(13)(14). Remifentanil is shown to attenuate hemodynamic replication to intubation.…”

“…Further, it is ultra-short acting opioid and very metabolized by placenta esterase, thus the fetal to maternal ratio is low. It has a short onset and rapid recovery time as well (1,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Similarly, labetalol is an α and (β 1 & β 2 ) adrenergic receptor blocker and competes with the other catecholamine for binding these sites, therefore, it can suppress increased blood pressure (BP) and heart rate owing to the activation of the sympathetic nervous system during the intubation (9,16).…”