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Induction opioids during C-section do not affect delivery, neonatal outcomes

03 Nov 2019

Induction opioids such as alfentanil and remifentanil do not appear to impact Apgar scores and neonatal airway outcomes after caesarean section, reports a recent meta-analysis.

After applying the selection criteria, 17 studies remained eligible for analysis. These studies comprised a total of 978 patients treated with either remifentanil, alfentanil or fentanyl and whose outcomes were compared against placebo controls. The databases accessed were the Cochrane trials registry, CINAHL, PubMed, Web of Science, SCOPUS and Medline.

Twelve studies evaluated Apgar scores at 1 minute after giving birth. Induction opioids did lead to significant changes (weighted mean difference [WMD], –0.05, 95 percent confidence interval [CI], –0.23 to 0.13; p=0.60).

Disaggregating according to opioid type yielded the same result: remifentanil (WMD, –0.27, 95 percent CI, –0.74 to 0.19; p=0.25), alfentanil (WMD, 0.05, 95 percent CI, –0.12 to 0.21; p=0.58) and fentanyl (WMD: –0.02, 95 percent CI, –0.30 to 0.26; p=0.89). Apgar scores at 5 minutes postdelivery were similarly unaffected by the overall use of induction opioids, or the use of specific types, except for fentanyl (WMD, –0.20, 95 percent CI, –0.33 to –0.08; p=0.002).

Induction opioids were likewise unrelated to the need for neonatal respiratory interventions. Remifentanil, for instance, did not significantly increase the likelihood of using bag-mask ventilation (risk ratio [RR], 1.41, 95 percent CI, 0.88–2.39; p=0.71), neonatal intubation rate (RR, 1.34, 95 percent CI, 0.67–2.68; p=0.97) and neonatal intensive care unit (NICU) admission (RR, 0.95, 95 percent CI, 0.77–1.19; p=0.67).

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Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
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Pearl Toh, 6 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
12 Jan 2020
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.