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

BACKGROUND: Remifentanil 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 uncl...

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Autores principales: Noskova, Pavlina, Blaha, Jan, Bakhouche, Hana, Kubatova, Jana, Ulrichova, Jitka, Marusicova, Patricia, Smisek, Jan, Parizek, Antonin, Slanar, Ondrej, Michalek, Pavel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377196/
https://www.ncbi.nlm.nih.gov/pubmed/25821405
http://dx.doi.org/10.1186/s12871-015-0020-1
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author Noskova, Pavlina
Blaha, Jan
Bakhouche, Hana
Kubatova, Jana
Ulrichova, Jitka
Marusicova, Patricia
Smisek, Jan
Parizek, Antonin
Slanar, Ondrej
Michalek, Pavel
author_facet Noskova, Pavlina
Blaha, Jan
Bakhouche, Hana
Kubatova, Jana
Ulrichova, Jitka
Marusicova, Patricia
Smisek, Jan
Parizek, Antonin
Slanar, Ondrej
Michalek, Pavel
author_sort Noskova, Pavlina
collection PubMed
description BACKGROUND: Remifentanil 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. METHODS: Using 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). RESULTS: The 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. CONCLUSION: At 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 REGISTRATION: ClinicalTrials.gov: NCT01550640.
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spelling pubmed-43771962015-03-30 Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial Noskova, Pavlina Blaha, Jan Bakhouche, Hana Kubatova, Jana Ulrichova, Jitka Marusicova, Patricia Smisek, Jan Parizek, Antonin Slanar, Ondrej Michalek, Pavel BMC Anesthesiol Research Article BACKGROUND: Remifentanil 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. METHODS: Using 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). RESULTS: The 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. CONCLUSION: At 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 REGISTRATION: ClinicalTrials.gov: NCT01550640. BioMed Central 2015-03-26 /pmc/articles/PMC4377196/ /pubmed/25821405 http://dx.doi.org/10.1186/s12871-015-0020-1 Text en © Noskova et al.; licensee BioMed Central. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Noskova, Pavlina
Blaha, Jan
Bakhouche, Hana
Kubatova, Jana
Ulrichova, Jitka
Marusicova, Patricia
Smisek, Jan
Parizek, Antonin
Slanar, Ondrej
Michalek, Pavel
Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
title Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
title_full Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
title_fullStr Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
title_full_unstemmed Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
title_short Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
title_sort neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377196/
https://www.ncbi.nlm.nih.gov/pubmed/25821405
http://dx.doi.org/10.1186/s12871-015-0020-1
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