title: Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01550640.
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
authors.forename: Pavlina
authors.initials: P
authors.lastname: Noskova
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Blaha
authors.affiliation: Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Albertov 4, 128 00 Praha 2, Czech Republic.
authors.forename: Hana
authors.initials: H
authors.lastname: Bakhouche
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Kubatova
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
authors.forename: Jitka
authors.initials: J
authors.lastname: Ulrichova
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
authors.forename: Patricia
authors.initials: P
authors.lastname: Marusicova
authors.affiliation: Neonatology, Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 51 Praha 2, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Smisek
authors.affiliation: Department of Gynaecology and Obstetrics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 18, 128 51 Praha 2, Czech Republic.
authors.forename: Antonin
authors.initials: A
authors.lastname: Parizek
authors.affiliation: Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Albertov 4, 128 00 Praha 2, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Slanar
authors.affiliation: Department of Anaesthesiology, Resuscitation and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08 Praha 2, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Michalek
mesh_terms: D000222:Adaptation, Physiological / Q000187:drug effects; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects; D018681:Anesthetics, General / Q000009:adverse effects*; D001034:Apgar Score; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D000077208:Remifentanil; D012120:Respiration Disorders / Q000139:chemically induced*; D012121:Respiration, Artificial; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D018681:Anesthetics, General; D010880:Piperidines; D000077208:Remifentanil
keywords: Caesarean delivery; General anaesthesia; Neonatal effect; Remifentanil
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