Background Umbilical artery serum-derived exosomes (UEs) serve as messengers for maternal–fetal information exchange and cellular regulation. Intravenous remifentanil could be considered as an effective adjunct to epidural anesthesia in providing a favorable analgesia effect for cesarean section (C-section), but its effects on UEs are currently unknown. Methods From 01/12/2021 to 30/06/2022, eligible parturients scheduled for repeated C-section at the First Affiliated Hospital of Wenzhou Medical University were randomized to receive either an intravenous bolus (0.15 μg/kg) followed by a continuous infusion (0.075 μg/kg/min) of remifentanil or normal saline throughout the procedure. The primary outcome was the number of UEs. Secondary outcomes included the size and protein amount of UEs, the vital signs, visceral pain score, sedation score, maternal satisfaction score, Apgar score, the incidence of neonatal asphyxia, umbilical arterial pH, and the presence of complications. Results Nanoparticle tracking analysis indicated similar size of UEs between the two groups, but the number and protein amount of UEs were increased in the remifentanil group compared to the control group (P < 0.05). In parturients receiving remifentanil, visceral pain scores were decreased, which was accompanied by the increased scores of maternal satisfaction with the anesthetic method (P < 0.05). Other maternal and neonatal outcomes were comparable between the two groups (P > 0.05). Conclusion The intravenous administration of remifentanil increased the number of UEs in parturients undergoing repeated C-section under epidural anesthesia, with improved birth experience and minimal neonatal complications.
Backgroud: Women in labor who receive epidural analgesia are more likely to experience intrapartum fever, which is defined as Epidural-related maternal fever (ERMF). The mechanisms of ERMF remain incompletely understood. At present, there are no effective means to prevent epidural-associated fever. This study was to investigate the effects of different concentrations of ropivacaine on intrapartum fever and pyrogenic factors during epidural labor analgesia. Methods 123 full-term single first-term primiparas who were hospitalized for delivery and willing to receive patient-controlled epidural analgesia (PCEA) were selected as research objects. Analgesia was randomly provided with one of three groups: (Group A) 0.0625% ropivacaine with 1ug/ml fentanyl, (Group B) 0.075% ropivacaine with 1ug/ml fentanyl, (Group C) 0.1% ropivacaine with 1ug/ml fentanyl. The primary outcome was the tympanic temperature. The secondary outcomes included plasma inflammatory factor levels, VAS score, labor duration and neonatal Apgar score. Results At T2(T2 = four hours after analgesia), the average body temperature of Group C was higher than that of the other two groups (P < 0.05, Table 2), but there was no significant difference between Group A and Group B (P > 0.05, Table 2). At T3(T3 = eight hours after analgesia), the average temperature of Group C was higher than that of Group B and that of Group B was higher than that of Group A (P < 0.05, Table 2). At T2, plasma thermogenesis factors IL-6, TNF-α, PGE2 and RANTES in Group C were higher than those in Group A and Group B (P < 0.05), but there was no significant difference between Group A and group B (P > 0.05). At T3, the above inflammatory factors in group C were higher than those in group B (P < 0.05), and those in group B were higher than those in group A (P < 0.05). There were no significant differences in delivery time, VAS score and neonatal Apgar score among the three groups (P > 0.05). Conclusions This study suggests that lower concentration of ropivacaine results in lower tympanic temperature, which was associated with lower levels of inflammatory factors. Trial registration: This prospective and randomized control trial was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/edit.aspx?pid=141149&htm=4, identification number: ChiCTR2100053761; principal investigator: Xiangqing Xiong; date of registration: 29/11/2021) before patient enrollment.
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