Neonatal Respiratory Depression and Intrathecal Fentanyl

  • V.H. González Cárdenas 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
Keywords: Anesthesia, Conduction, Cesarean section, Prevalence, Respiratory insufficiency


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

MethodsCross-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).

ConclusionsThe 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.


1. Resolución No. 008430 de 1993 (04 de Octubre de 1993), Ministerio de Protección Social de la República de Colombia.
2. Littleford J. Effects on the fetus and newborn of maternal analgesia and anesthesia: a review; Obstetrical and Pediatric Anesthesia. Can J Anesth. 2004;51:586-609.
3. Smith CV, Rayburn WF, Allen KV, Bane TM, Livezey GT. Influence of intravenous fentanyl on fetal biophysical parameters during labor. J Matern Fetal Med. 1996;5:89-92.
4. Nikkola EM, Kirjavainen TT, Ekblad UU, Kero PO, Salonen MA. Postnatal adaptation after caesarean section or vaginal delivery, studied with the staticcharge-sensitive bed. Acta Paediatr. 2002;91:927-33.
5. Cowan CM, Kendall JB, Barclay PM, Wilkes RG. Comparison of intratechal fentanyl and diamorphine in addition to bupivacaine for Caesarean section under spinal anesthesia. Br J Anaesth. 2002;89:452-8.
6. Frölich MA, Burchfield DJ, Euliano TY, Caton D. A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neonatal effects. Can J Anesth. 2006;53:79-85.
7. Shende D, Cooper GM, Bowden MI. The influence of intrathecal fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia. 1998;53:702-10.
8. Kelly MC, Carabine UA, Mirakhur RK. Intrathecal for diamorphine for analgesia after caesarean section. Anaesthesia. 1998;53:231-7.
9. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al. Perioperative analgesia with subarachnoid fentanil-bupivacaine for cesarean delivery. Anesthesiology. 1989;71:535-40.
10. Belzarena SD. Clinical effects of intrathecally administered fentayl in patients undergoing cesarean section. Anesth Analg. 1992;74:653-7.
11. Mardirosoff C, Dumont L, Boulvain M, Tramer MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review. BJOG. 2002;109:274-81.
12. American Society of Anesthesiologists Task Force on Neuroaxial Opioids: Terese Horlocker (Chair) et al; Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuroaxial Administration. Anesthesiology. 2009;110:218-30.
13. Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Pharm D, Sullivan JT, et al. The risk of cesarean delivery with neuroaxial analgesia given early versus late in labor. N Engl J Med. 2005;352:655-65.
14. Alvarez S, Perdomo C, Salinas C, Garcia L. Efectos del fentanyl adicionado a Bupivacaína en anestesia peridural para operación cesárea. Rev Colomb Anestesiol. 2002;30: 23-31.
How to Cite
González Cárdenas V. Neonatal Respiratory Depression and Intrathecal Fentanyl. Colomb. J. Anesthesiol. [Internet]. 2012 Apr. 1 [cited 2024 Feb. 28];40(2):100-5. Available from:


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How to Cite
González Cárdenas V. Neonatal Respiratory Depression and Intrathecal Fentanyl. Colomb. J. Anesthesiol. [Internet]. 2012 Apr. 1 [cited 2024 Feb. 28];40(2):100-5. Available from:


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