Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial

2008 ◽  
Vol 17 (2) ◽  
pp. 130-136 ◽  
Author(s):  
G. Draisci ◽  
A. Valente ◽  
E. Suppa ◽  
L. Frassanito ◽  
R. Pinto ◽  
...  
QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
E Elshaer ◽  
H Omar ◽  
A Elshaer ◽  
T Youssif ◽  
W Abdelmoneim

Abstract Background Cesarean delivery is one of the most current surgeries in women and one of the most significant challenges of anesthesiologists in this kind of surgery is the fetuses' exposure to anesthetic drugs. Regional anesthesia is generally preferred during cesarean section, but general anesthesia may be the only option under certain circumstances such as patient preference, back deformities. The most common drugs which are used in cesarean section to induce general anesthesia are thiopental sodium and propofol. Aim compare the effect of sodium thiopental induction versus propofol induction on hemodynamics of mothers undergoing elective cesarean section under general anesthesia and their effect on Apgar score of their newborns. Materials and Methods A total 260 healthy patients were included in an open randomized study, among whom 130 patients received Thiopentone and 130 received Propofol. These patients were premedicated with granisetron and ranitidine, after induction dose the maintenance was similar for both groups. APGAR scoring and umbilical cord venous gas analysis were among the parameters used for determining the general well-being of newborns. There were no significant difference between the two groups regarding Apgar scoring in 1st, 2nd and 5th minutes. Umbilical cord blood gas values were similar . There was no metabolic acidosis in newborns of mothers receiving thiopental or propofol as anesthetic agents during cesarean section. Results Group (T) received general anesthesia with thiopental at a dose of ( 4-6 mg/kg) while patients in group (P) received general anesthesia with propofol at a dose of (2mg/kg). As regards hemodynamic changes, there were no significant difference in maternal heart rate, systolic blood pressure, diastolic blood pressure and mean blood pressure during their measurement throughout the procedure-preoperatively, after delivery of the baby,15 minutes after delivery, after extubation and in recovery room- but after intubation, there were significantly lower in propofol group which suppressed hemodynamic response to intubation . Conclusion Thiopental and propofol can be safely used in cesarean sections, but the use of propofol is more advantageous than thiopental because it provides adequate anesthetic suppression of pressor response of intubation without any depressive effect on newborns.


2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Ramesh Bhattarai ◽  
Rajiv Shah ◽  
Sita Dhakal ◽  
Pragya Malla ◽  
Srijana Sapkota

Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal. Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period   in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome. Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request  two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal   Conclusions:  General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.  


2019 ◽  
Vol 15 (4) ◽  
pp. 232-237
Author(s):  
Mir Hadi Musavi ◽  
Behzad Jodeiri ◽  
Keyvan Mirnia ◽  
Morteza Ghojazadeh ◽  
Zeinab Nikniaz

Background: Although, some clinical trials investigated the maternal and neonatal effect of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best of our knowledge, there is no systematic review to summarize these results. Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean section. Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July 2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a premedication before induction of general anesthesia compared with placebo on neonate first and fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section. Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. Results: The present systematic review and meta-analysis consisted of three clinical trials including 180 women in labor. Considering the results of meta-analysis, there is no significant differences between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5 minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: - 0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: - 0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were significantly lower compared with placebo group. Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had positive effects on preventing adverse consequences of intubation on maternal hemodynamics.


2021 ◽  
Vol 22 ◽  
pp. 100152
Author(s):  
Ahmad khaled Abubaker ◽  
Haya Yacoub Alul ◽  
Isam K. Bsisu ◽  
Daher K. Rabadi ◽  
Ismail Ragab AbuAlsha'r ◽  
...  

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Junnosuke Kimura ◽  
Kento Kawamura ◽  
Manami Minoura ◽  
Ayako Hiramoto ◽  
Yoshifumi Suga ◽  
...  

Abstract Background We report a case in which a list of high-risk pregnant women on cloud-based business communication tools was useful in formulating an anesthetic plan for unscheduled cesarean section. Case presentation A 37-year-old woman, who had been prescribed icosapentate for hypertriglyceridemia, received an antenatal anesthetic evaluation for possible cesarean delivery, and it was agreed that the anesthetic method for emergency cesarean section was general anesthesia if the surgery would take place within 7 days after the discontinuation of the drug, and regional anesthesia if it would take place any time later. Then this agreement was uploaded on the cloud-based business communication tools, and updated until she delivered her baby via unscheduled cesarean section. Conclusions A cloud-based business communication tools was useful in formulating an anesthesia plan for a patient undergoing a cesarean delivery. However, more discussion would be needed to utilize it in security.


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