title: Pre-delivery remifentanil infusion for placenta accreta cesarean delivery under general anesthesia: an observational study.
abstract: OBJECTIVE
  General anesthesia may be required for placenta accreta cesarean delivery. Intrauterine fetal anesthetic exposure should be minimized to avoid neonatal respiratory depression; opioids are often delayed until post-delivery.
  
  
  METHODS
  In this observational study, we compared neonatal outcome using pre-delivery remifentanil versus post-delivery (deferred) opioids for placenta accreta cesarean delivery. Choice of anesthesia was discretionary. The primary outcome was Apgar score at 5 min comparing women who received pre-delivery remifentanil versus deferred opioid administration. We recorded maternal/obstetric characteristics, surgical characteristics, maternal hemodynamic data, neonatal outcomes: Apgar scores, umbilical vein pH and respiratory interventions at birth.
  
  
  RESULTS
  Between February 2007 and April 2014 we identified 40 general anesthesia placenta accreta cesarean deliveries. The remifentanil dose rate ranged from 0.06 to 0.46 mcg kg(-1 )min(-1). Obstetric and maternal characteristics were similar. Neonatal Apgar, umbilical pH and respiratory intervention outcomes were similar in both groups; Apgar scores median (interquartile range IQR [range]) at 5 min were 9 (8-10) for pre-delivery remifentanil versus 9 (9-10) for deferred opioid administration, p = 0.18.
  
  
  CONCLUSIONS
  We did not observe a significant effect on neonatal Apgar scores at 1 and 5 min, or respiratory interventions at birth when remifentanil infusion was administered pre-delivery.
authors.affiliation: a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and.
authors.forename: R
authors.initials: R
authors.lastname: Shaylor
authors.affiliation: a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and.
authors.forename: Y
authors.initials: Y
authors.lastname: Ginosar
authors.affiliation: a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and.
authors.forename: A
authors.initials: A
authors.lastname: Avidan
authors.affiliation: b Department of Neonatology , Hadassah Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: S
authors.initials: S
authors.lastname: Eventov-Friedman
authors.affiliation: a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and.
authors.forename: N
authors.initials: N
authors.lastname: Amison
authors.affiliation: a Department of Anesthesiology and Critical Care Medicine , Hadassah Hebrew University Medical Center , Jerusalem , Israel and.
authors.forename: C F
authors.initials: CF
authors.lastname: Weiniger
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001034:Apgar Score; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced*; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D010921:Placenta Accreta; D011247:Pregnancy; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil
keywords: Apgar; cesarean delivery; placenta accreta; remifentanil