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Departments of
*Anaesthesia and Intensive Care and
Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
Address correspondence to Dr. Tony Gin, Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. Address e-mail to tgin{at}cuhk.edu.hk
Opioids are routinely omitted at the induction of general anesthesia for cesarean delivery because of concerns about neonatal respiratory depression. The subsequent unmodified maternal stress response to tracheal intubation reduces placental perfusion. The short-acting opioid alfentanil may afford advantages at the induction, without subsequent neonatal depression. In this double-blinded study of elective cesarean deliveries, 40 patients were allocated randomly to receive either alfentanil 10 µg/kg (n = 18) or placebo (n = 22), 1 min before the induction of anesthesia with thiopental 4 mg/kg and succinylcholine 1.5 mg/kg. Anesthesia was maintained with 50% nitrous oxide, 0.5% isoflurane in oxygen, and atracurium. Neonates were assessed by using Apgar scores, Neurologic and Adaptive Capacity Scores, and umbilical cord blood gas and catecholamine analysis. After intubation, mothers receiving alfentanil had a smaller increase in mean arterial blood pressure, (11 ± 15 vs 31 ± 13 mm Hg, P < 0.001) and lower plasma norepinephrine concentrations, (336 ± 152 vs 486 ± 241 pg/mL, P < 0.05). Neonates in the alfentanil group had greater umbilical arterial oxygen tensions (27.8 ± 7.0 vs 22.6 ± 7.4 mm Hg), slightly reduced Apgar scores (both P < 0.05), but similar Neurologic and Adaptive Capacity Scores. One neonate in the alfentanil group required naloxone. The maternal stress response was attenuated in the alfentanil group but at the cost of early neonatal depression. However, all neonates should be monitored for possible immediate, but transient, respiratory depression.
Implications: Alfentanil 10 µg/kg given at the induction of general anesthesia for cesarean delivery attenuates the subsequent maternal stress response. However, all neonates should be monitored for possible immediate but transient respiratory depression.
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W. D. Ngan Kee, K. S. Khaw, K. C. Ma, A. S. Y. Wong, and B. B. Lee Randomized, double-blind comparison of different inspired oxygen fractions during general anaesthesia for Caesarean section{dagger} Br. J. Anaesth., October 1, 2002; 89(4): 556 - 561. [Abstract] [Full Text] [PDF]
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