Maghsoudloo Maziyar, Eftekhar Negar, Ashraf Mohammad Ali Noyan, Khan Zahid Husain, Sereshkeh Homeira Peiravy
Department of Anesthesiology, Imam Khomeini General Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2011;49(8):517-22.
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 (P<0.05). The 1st and 5th minute's Apgar scores of the neonate and umbilical cord arterial and venous blood gas analysis were not statistically different between two groups (P>0.05). 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.
全身麻醉诱导期间使用阿片类药物是产科麻醉中的一项具有挑战性的工作。本研究的目的是调查全身麻醉诱导前静脉注射芬太尼对择期剖宫产手术新生儿“1分钟和5分钟阿氏评分”的影响。在伊朗德黑兰瓦利 - 阿斯尔医院进行的一项双盲随机临床试验中，60例接受全身麻醉下择期剖宫产手术的产妇被随机分为两组：干预组和对照组。干预组在麻醉诱导前3分钟静脉注射1μg/kg芬太尼。两组的诱导途径、喉镜检查和气管插管方式相同。在麻醉诱导前（作为基线测量）以及喉镜检查和插管期间记录血压（BP）和心率（HR）。比较两组新生儿1分钟和5分钟的阿氏评分以及脐动脉和脐静脉血样的pH值。诱导前后以及插管后不同时间的收缩压、舒张压、平均动脉压和心率变化在两组之间存在显著差异（P<0.05）。两组新生儿1分钟和5分钟的阿氏评分以及脐动脉和脐静脉血气分析在统计学上无差异（P>0.05）。基于本研究结果，剖宫产麻醉诱导前3分钟静脉注射1μg/Kg芬太尼可使母亲的血流动力学状况稳定，且对新生儿结局无影响。芬太尼对阿氏评分以及脐动脉和脐静脉血气分析无影响，可能可安全用于择期剖宫产手术。需要更多研究以获得更清晰的认识。
