Propofol in combination with remifentanil for cesarean section: Placental transfer and effect on mothers and newborns at different induction to delivery intervals

Hu, Liguo; Pan, Jiang; Shan-tang, Zhang; Yu, Jinjing; He, Keqiang; Shu, Shuhua; Wang, Ruiting

doi:10.1016/j.tjog.2016.09.010

Cited by 25 publications

(24 citation statements)

References 25 publications

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“…Table 1; for all online suppl. material, see www.karger.com/doi/10.1159/000512489) [1][2][3]. In DOI: 10.1159/000512489 2016, the US Food and Drug Administration issued a warning that the exposure of the developing brain to anesthesia might be associated with impaired neurocognitive outcome later in life [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effects of Maternal Abdominal Surgery on Fetal Brain Development in the Rabbit Model

Bleeser¹,

Veeken²,

Devroe³

et al. 2021

Fetal Diagn Ther

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Introduction: Anesthesia during pregnancy can impair fetal neurodevelopment, but effects of surgery remain unknown. The aim is to investigate effects of abdominal surgery on fetal brain development. Hypothesis is that surgery impairs outcome. Methods: Pregnant rabbits were randomized at 28 days of gestation to 2 h of general anesthesia (sevoflurane group, n = 6) or to anesthesia plus laparoscopic appendectomy (surgery group, n = 13). On postnatal day 1, neurobehavior of pups was assessed and brains harvested. Primary outcome was neuron density in the frontal cortex, and secondary outcomes included neurobehavioral assessment and other histological parameters. Results: Fetal survival was lower in the surgery group: 54 versus 100% litters alive at birth (p = 0.0442). In alive litters, pup survival until harvesting was 50 versus 69% (p = 0.0352). No differences were observed for primary outcome (p = 0.5114) for surviving pups. Neuron densities were significantly lower in the surgery group in the caudate nucleus (p = 0.0180), but not different in other regions. No differences were observed for secondary outcomes. Conclusions did not change after adjustment for mortality. Conclusion: Abdominal surgery in pregnant rabbits at a gestational age corresponding to the end of human second trimester results in limited neurohistological changes but not in neurobehavioral impairments. High intrauterine mortality limits translation to clinical scenario, where fetal mortality is close to zero.

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Section: Introductionmentioning

confidence: 99%

Effects of Maternal Abdominal Surgery on Fetal Brain Development in the Rabbit Model

Bleeser¹,

Veeken²,

Devroe³

et al. 2021

Fetal Diagn Ther

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“…The basis of this assumption is that GA lowers the Apgar score, maternal hypotension that may occur with SA can be controlled by suitable vasopressors and the low medication dose required for SA induction does not cause systemic effects in neonates (8). Patients with contraindications for RA are administered GA for cesareans; at this point, the greatest concern is the effect of anesthetic agents on the neonates (9).…”

Section: Discussionmentioning

confidence: 99%

Effect of Anesthesia Methods During Elective Cesareans on Neonates: Ordu Province Example

Ertürk

Gültekin

Arıcı

2021

Middle Black Sea Journal of Health Science

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Objective: To research the short-term effects on neonates of different anesthesia methods administered for elective cesareans. Methods: Data obtained from files and electronic medical records of 157 singleton cesarean cases and neonates from January 2018 to December 2019 were retrospectively analyzed and 6 cases were excluded from the study. A total of 151 cases were divided into general anesthesia-propofol (n=30), spinal (n=100) and general anesthesia-pentothal (n=21) groups. Results: A total of 151 cesarean cases that meet the inclusion criteria in the date interval of the study were assessed. Of cases, 100 (66%) were in the spinal anesthesia group, 30 (20%) were in the general anesthesiapropofol group and 21 (14%) were in the general anesthesia-pentothal group. There was no significant difference between the study groups in terms of demographic data. The umbilical cord pCO2 value was significantly low in the spinal anesthesia group (43.60±5.52) compared to the general-pentothal group (47.38±5.71). The umbilical cord HCO3 value was lower in the spinal anesthesia group (22.69±1.62) compared to the general-pentothal (23.48±1.53) and general-propofol groups (23.49±1.83). There was a significant variation in postnatal treatment types according to anesthesia method (p=0.012). The rate not requiring treatment was lowest in the general-propofol group (46.7%), while the rate of balloon-valve mask use (46.7%) was highest compared to the other groups. In terms of 5th minute Apgar scores, there was a significant difference between the groups (p=0.024). Patients in the general-propofol group had significantly lower 5th minute Apgar scores compared to patients in the spinal group. Conclusion:The balloon-valve mask rate was highest for those with propofol general anesthesia. Additionally, it was identified that neonates in both general anesthesia groups had higher neonatal intensive care unit requirements compared to the spinal anesthesia group.

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“…Reduced catecholamine response compared to control was noted at the intubation, but not at delivery, so a single remifentanil dose did not manage to prevent catecholamine rise during the whole period. Hu et al [10] measured umbilical arterial and venous remifentanil concentration at delivery and proved rapid remifentanil metabolism in fetal circulation, but emphasized that it can be affected by the differences in dosing regimens.…”

Section: Discussionmentioning

confidence: 99%

“…Remifentanil has rapid onset of action (1-1.5 min. ), rapid redistribution and metabolism dependent on nonspecific tissue and plasma esterases; its context sensitive half time is three min; it crosses the placenta, but appears to be rapidly metabolized and redistributed in the fetus, leaving the small possibility of neonatal adverse effects [2,4,7,9,10].…”

Section: Introductionmentioning

confidence: 99%

The effect of remifentanil used during caesarean section on maternal hemodynamics and neonatal outcome - comparison of two dosing regimens

2019

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Introduction/Objective To present and compare maternal and neonatal effects of two remifentanil dosing regimens, used during induction-delivery period of elective caesarean section in attempt to attenuate maternal cardiovascular response to surgical stress. Methods Seventy-seven ASA I-II parturients were randomly divided into three groups and received the following: A-1 µg/kg remifentanil immediately before the induction to anesthesia followed by 0.15 µg/ kg/min infusion, interrupted after skin incision; B-1 µg/kg remifentanil bolus immediately before the induction; C-no remifentanil until delivery. Hemodynamic (blood pressure, heart rate) and bispectral index changes after endotracheal intubation, skin incision, peritoneal incision and delivery, intraoperative anesthetics consumption and neonatal outcome have been compared between the groups. Results Hemodynamic response to intubation was significantly attenuated (p < 0.001) in groups A and B compared to C. Hemodynamic response to skin incision, peritoneal incision and delivery was significantly attenuated in group A compared to B and C. Thiopentone dose in groups A and B was lower than in group C (p < 0.001); sevoflurane and remifentanil consumption was less in group A compared to B and C (p < 0.001). Apgar scores at 1st minute were ≥ 8 in all neonates, with no differences in neonatal heart rate, oxygen saturation and umbilical blood gas values (all within normal range). Conclusion 1 µg/kg remifentanil bolus followed by 0.15 µg/kg/min stopped after skin incision, successfully blunted maternal hemodynamic stress response throughout whole induction-delivery period, reduced anesthetic consumption, without affecting neonatal outcome, so it can be considered effective as well as safe to use during induction-delivery period of caesarean section.

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Propofol in combination with remifentanil for cesarean section: Placental transfer and effect on mothers and newborns at different induction to delivery intervals

Abstract: It is safe to administer propofol in combination with remifentanil by continuous infusion after the bolus dose for the induction of anesthesia during cesarean section. Prolonging the I-D interval within a certain limit will not have any significant influence on the fetus.

Cited by 25 publications

References 25 publications

Effects of Maternal Abdominal Surgery on Fetal Brain Development in the Rabbit Model

Effects of Maternal Abdominal Surgery on Fetal Brain Development in the Rabbit Model

Effect of Anesthesia Methods During Elective Cesareans on Neonates: Ordu Province Example

The effect of remifentanil used during caesarean section on maternal hemodynamics and neonatal outcome - comparison of two dosing regimens

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