Original Article

Does Intravenous Fentanyl Affect Apgar Scores and Umbilical Vessel Blood Gas Parameters in Cesarean Section Under General Anesthesia?

Abstract

The administration of opioids during induction of general anesthesia is a matter of challenge in obstetric anesthesia. The aim of this study was to investigate the effects of intravenous fentanyl before induction of general anesthesia on the"1st and 5th minutes' Apgar scores" in neonates with elective cesarean surgery. In a double blinded randomized clinical trial on 60 parturients undergoing elective cesarean surgeries under general anesthesia in Vali-e-Asr Hospital, in Tehran, Iran, were divided randomly into two groups; the intervention group and the control. In intervention group, intravenous fentanyl 1µg/kg was administrated three minutes before anesthesia induction. The induction route, laryngoscopy and tracheal intubation were the same in the groups. The blood pressure (BP) and heart rate (HR) measures were recorded before anesthesia induction (as baseline measures) and so during laryngoscopy and intubation. The 1st and 5th minute's apgar scores and the pH of umbilical cord arterial and venous samples were compared in two groups. The systolic and diastolic blood pressure, mean arterial pressure and heart rate changes before and after induction and in various times after intubation showed significant difference between two groups (P0.05). Based on the results of this study, the administration of 1 µg/Kg intravenous Fentanyl, three minutes before induction of anesthesia for cesarean section can lead to a stable hemodynamic situation in mother and showed no effects on neonate`s outcomes. Fentanyl showed no effects on Apgar scores and on umbilical cord arterial and venous blood gases analysis and it probably can be used safely in elective cesarean surgeries. More studies are required to obtain a clear view.

Crawford JS. Fetal well-being and maternal awareness. Br J Anaesth 1988;61(3):247-9.

Moir DD. Anaesthesia for Caesarean section. An evaluation of a method using low concentrations of halothane and 50 per cent of oxygen. Br J Anaesth 1970;42(2):136-42.

Jaslow D, Klimke A, Cunnius P, Neubert D. Prehospital pharmacology: is Fentanyl a 21st century replacement for morphine? JEMS 2007;36(9):105-9.

Craft JB Jr, Coaldrake LA, Bolan JC, Mondino M, Mazel P, Gilman RM, Shokes LK, Woolf WA. Placental passage and uterine effects of fentanyl. Anesth Analg 1983;62(10):894-8.

Koehntop DE, Rodman JH, Brundage DM, Hegland MG, Buckley JJ. Pharmacokinetics of fentanyl in neonates. Anesth Analg 1986;65(3):227-32.

Thorp JA, Rushing RS. Umbilical cord blood gas analysis. Obstet Gynecol Clin North Am 1999;26(4):695-709.

Loeser JD, Butler SH, Chapman CR, Turk CDC, editors. Bonica's Management of Pain. 3rd ed. Baltimore, MD: Lippincott Williams and Wilkins; 2000. p. 1893-952.

Birnbach DJ, Browne IM. Anesthesia for obstetrics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller’s Anesthesia. 7th ed. USA: Churchill Livinstone Elsevier; 2010. p. 2055.

Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984;61(3):276-310.

Rouby JJ, Andreev A, Léger P, Arthaud M, Landault C, Vicaut E, Maistre G, Eurin J, Gandjbakch I, Viars P. Peripheral vascular effects of thiopental and propofol in humans with artificial hearts. Anesthesiology 1991;75(1):32-42.

Rayburn WF, Smith CV, Parriott JE, Woods RE. Randomized comparison of meperidine and fentanyl during labor. Obstet Gynecol 1989;74(4):604-6.

Saarenmaa E, Neuvonen PJ, Fellman V. Gestational age and birth weight effects on plasma clearance of fentanyl in newborn infants. J Pediatr 2000;136(6):767-70.

Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology 2005;103(6):1211-7.

Nikkola EM, Ekblad UU, Kero PO, Alihanka JJ, Salonen MA. Intravenous fentanyl PCA during labour. Can J Anaesth 1997;44(12):1248-55.

Rosaeg OP, Kitts JB, Koren G, Byford LJ. Maternal and fetal effects of intravenous patient-controlled fentanyl analgesia during labour in a thrombocytopenic parturient. Can J Anaesth 1992;39(3):277-81.

Garner EG, Smith CV, Rayburn WF. Maternal respiratory arrest associated with intravenous fentanyl use during labor. A case report. J Reprod Med 1994;39(10):818-20.

Rayburn WF, Smith CV, Leuschen MP, Hoffman KA, Flores CS. Comparison of patient-controlled and nurseadministered analgesia using intravenous fentanyl during labor. Anesthesiol Rev 1991;18(1):31-6.

Kan RE, Hughes SC, Rosen MA, Kessin C, Preston PG, Lobo EP. Intravenous remifentanil: placental transfer, maternal and neonatal effects. Anesthesiology 1998;88(6):1467-74.

Scott H, Bateman C, Price M. The use of remifentanil in general anaesthesia for caesarean section in a patient with mitral valve disease. Anaesthesia 1998;53(7):695-7.

Thorp JA, Sampson JE, Parisi VM, Creasy RK. Routine umbilical cord blood gas determinations? Am J Obstet Gynecol 1989;161(3):600-5.

Riley RJ, Johnson JW. Collecting and analyzing cord blood gases. Clin Obstet Gynecol 1993;36(1):13-23.

Low JA, Galbraith RS, Muir DW, Killen HL, Pater EA, Karchmar EJ. Factors associated with motor and cognitive deficits in children after intrapartum fetal hypoxia. Am J Obstet Gynecol 1984;148(5):533-9.

Low JA, Panagiotopoulos C, Derrick EJ. Newborn complications after intrapartum asphyxia with metabolic acidosis in the term fetus. Am J Obstet Gynecol 1994;170(4):1081-7.

Dennis J, Johnson A, Mutch L, Yudkin P, Johnson P. Acid-base status at birth and neurodevelopmental outcome at four and one-half years. Am J Obstet Gynecol 1989;161(1):213-20.

Ruth VJ, Raivio KO. Perinatal brain damage: predictive value of metabolic acidosis and the Apgar score. BMJ 1988;297(6640):24-7.

Westgate J, Garibaldi JM, Greene KR. Umbilical cord blood gas analysis at delivery: a time for quality data. Br J Obstet Gynaecol 1994;101(12):1054-63.

Khoury AD, Moretti ML, Barton JR, Shaver DC, Sibai BM. Fetal blood sampling in patients undergoing elective cesarean section: a correlation with cord blood gas values obtained at delivery. Am J Obstet Gynecol 1991;165(4 Pt 1):1026-9

Files
IssueVol 49, No 8 (2011) QRcode
SectionOriginal Article(s)
Keywords
Fentanyl Apgar score Cesarean section General anesthesia
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Maghsoudloo M, Eftekhar N, Noyan Ashraf MA, Husain Khan Z, Peiravy Sereshkeh H. Does Intravenous Fentanyl Affect Apgar Scores and Umbilical Vessel Blood Gas Parameters in Cesarean Section Under General Anesthesia?. Acta Med Iran. 1;49(8):517-522.