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Inicio Colombian Journal of Anesthesiology Neonatal Respiratory Depression and Intrathecal Fentanyl
Información de la revista
Vol. 40. Núm. 2.
Páginas 100-105 (Mayo - Julio 2012)
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Vol. 40. Núm. 2.
Páginas 100-105 (Mayo - Julio 2012)
DOI: 10.1016/S2256-2087(12)70021-4
Acceso a texto completo
Neonatal Respiratory Depression and Intrathecal Fentanyl
Depresión respiratoria neonatal y fentanilo intratecal
Visitas
...
V.H. González Cárdenas??
Autor para correspondencia
vhgc79@yahoo.es

Corresponding author: Autopista Norte No 94-45, Bogotá, Colombia.
Physician and Surgeon, Anesthesiologist, Clinical Epidemiologist, Anesthesiology and Critical Care Instructor, La Samaritana University Hospital, Clinical Faculty, Universidad de la Sabana; Anesthesiologist, San José University Children's Hospital; FUCS Instructor, Intensivist Anesthesiologist, Colombia University Clinic, Sanitas Organisation; Department of Mother and Child Clinic, Saludcoop Corporation, Bogotá, Colombia
Información del artículo
Abstract
Objective

To establish the prevalence of neonatal respiratory depression in patients exposed to intrathecal fentanyl during Cesarean section.

Methods

Cross-sectional Analytical Observational Retrospective Study conducted at the Mother and Child Clinic of the Saludcoop Corporation in patients undergoing C-section who received intrathecal fentanyl for regional anesthesia in 2007 and 2008. Primary endpoints: low APGAR score (APGAR<7) and severe APGAR (APGAR<4).

Results

2165 records of C-sections and intrathecal fentanyl with a mean dose of 19.21mcg (SD=0.206mcg). Prevalence of low APGAR at 1.5 and 10 minutes was 1.77% (SD=0.63%), 0.11% (SD 0.163%), and 0%, respectively. The latter two values were different from the 1-minute value (ANOVA Scheffé Test, p=0.031) and there was no difference between them (minutes 5 and 10) (ANOVA p=0.861). Severely diminished APGAR results were, 0.059% (SD 0.058) 1 minute after birth and 0% at 5 and 10 minutes. There were no statistically significant differences between the three severely diminished values (ANOVA p=0.861).

Conclusions

The prevalence of respiratory depression measured with the APGAR test at birth is low; severely compromised APGAR shows a trend towards 0 in the different minutes of assessment. However, the reliability of the diagnostic tool (APGAR) is questionable, considering discrepancies when the analysis is done with a far more sensitive diagnostic tool (Silverman test).

The importance of this study relates only to the assessment of prevalence and its use as a source of a research hypothesis, and not as an association or prediction study.

Keywords:
Anesthesia
Conduction
Cesarean section
Prevalence
Respiratory insufficiency
Resumen
Objetivo

Establecer la prevalencia de depresión respiratoria neonatal en pacientes expuestas a fentanil intratecal durante cesárea.

Métodos

Estudio Observacional Retrospectivo Analítico Tipo Corte Transversal realizado en la Clínica Materno-Infantil de la Corporación Saludcoop en pacientes llevadas a cesárea y que recibieron Fentanil intratecal para anestesia regional en los años 2007 y 2008. Desenlaces primarios: APGAR Bajo (APGAR<7) y APGAR Severo (APGAR<4).

Resultados

2165 Registros de cesáreas y fentanil intratecal con dosis media de 19,21mcg (DE=0,206mcg). Prevalencia de APGAR Bajo al nacer al minuto 01=1,77% (DE=0,63%), al minuto 05=0,11% (DE 0,163%), al minuto 10=0%; siendo estos dos últimos valores diferentes al valor del minuto 01 (ANOVA Test Scheffé p=0,031) y sin diferenciarse entre ellos (minutos 5 y 10) (ANOVA p=0,861). APGAR Severamente disminuido al nacer al minuto 1=0,059% (DE 0,058), a los minutos 5 y 10=0%. Los tres valores severamente disminuidos no presentaron diferencias estadísticamente significativas entre sí (ANOVA p=0,861).

Conclusiones

La prevalencia de Depresión Respiratoria medido con el test de APGAR al nacer es baja; el compromiso severo del APGAR presenta una tendencia a 0 en todos los minutos de su valoración; aun así es cuestionable la fiabilidad de la herramienta diagnostica (APGAR) al existir discrepancias en el análisis con una escala mucho más sensible para el diagnostico (Test de Silverman).

La importancia de este estudio solo radica como evaluación de prevalencia y fuente de hipótesis de investigación, no como estudio de asociación o predicción.

Palabras clave:
Anestesia de conducción
Cesárea
Prevalencia
Insuficiencia respiratoria
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Copyright © 2012. Sociedad Colombiana de Anestesiología y Reanimación
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