Opioids for Cesarean delivery under general anesthesia and neonatal outcome: a historical cohort study

The lack of evidence-based recommendations for Cesarean delivery under general anesthesia can lead to practice variability and morbidity, particularly concerning the use of opioids. The goal of this study was to describe the practice for Cesarean delivery performed under general anesthesia and identify predictive factors for opioid use at anesthesia induction and the need for neonatal resuscitation.

We conducted a single-center historical cohort study. We included all adult parturients who underwent Cesarean delivery under general anesthesia between 1 January 2012 and 31 December 2016. We excluded patients who received general anesthesia after delivery or with known intrauterine fetal demise. We collected data on anesthetic medication use, maternal comorbidities, neonatal resuscitation, and anesthetic complications. We used logistic regression models to identify predictors of opioid use at anesthesia induction and predictors of neonatal resuscitation.

Two hundred and three patients were included. Propofol was the main induction agent (n = 195), 201 patients received neuromuscular blockers, and 67 received opioids. No maternal factors, including hypertensive disorders of pregnancy (odds ratio [OR], 1.94; 95% confidence interval [CI], 0.96 to 3.95; P = 0.06), were predictors of opioid use at induction of anesthesia. No statistical differences were detected between opioid administration groups, except for Cesarean indication, with preeclampsia being the main contributor. Low gestational age (OR, 0.75; 95% CI, 0.65 to 0.87; P = 0.002) was the only predictor of neonatal resuscitation.

Hypertensive disorders of pregnancy were not predictors of opioid use and opioid use was not a predictor of neonatal resuscitation. This suggests opioids could be used for maternal indications.