Remifentanil for General Anesthesia in the Context of Immaturity

NCT ID: NCT02029898

Last Updated: 2026-01-21

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 53 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-02-02
• Study Completion Date: 2018-06-22

Brief Summary

One of the problems during general anesthesia (GA) for caesarean section is the place of opioid agents. Indeed, the literature does not provide so far a clear answer regarding the use of opioids prior to extraction of the newborn. Indeed, if the opioid administration at induction is beneficial for the mother (better control of autonomic responses to noxious stimuli), the impact on the newborn can be unfavorable in terms of adaptation to extrauterine life . This is especially true if the birth takes place in a context of prematurity and / or acute fetal distress.

The pharmacokinetics of remifentanil make it the only opioid which is consistent with a rapid sequence induction. Its short period of action avoids the manual ventilation of patients before intubation, while providing a peak of action concomitant to the nociceptive stimulation. Patients at high risk of aspiration, including pregnant women, may benefit from this type of morphine at induction. In addition, the fact that remifentanil seems to be associated with relative fetal safety in obstetrical or neonatal context legitimized the development of protocols to study maternal-fetal consequences of the use of remifentanil at induction of AG for emergency caesarean section.

While cesarean section under general anesthesia mainly concern premature newborns in France, no work has focused on the use of remifentanil for caesarean section in a context of preterm without preeclampsia.

The main hypothesis of this study is to evaluate the safety of the use of remifentanil in terms of adaptation to extrauterine life in children born prematurely by caesarean section under general anesthesia outside the context of preeclampsia.

To do this, we will compare two groups of children, one consisting of children born by cesarean section under general anesthesia with maternal remifentanil infusion, the other made up of children born by cesarean section under general anesthesia without maternal infusion of remifentanil. This study is prospective, single-center, randomized, double-blinded.

The primary endpoint is formed by the value of the Apgar score less than 7 at 5 minutes, calculated in the delivery room by the team supporting the child (midwives and pediatricians).

The secondary endpoints are formed by maternal hemodynamic parameters (SBP, DBP, MAP, HR), the rate of complications during induction (difficult intubation, aspiration), the onset of respiratory distress requiring ventilation mask in the newborn, the rate of intubation in neonates, and the rate of use of adjuvant anesthetic agents.

Conditions

Cesarean Section; Anesthesia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: TRIPLE

Study Groups

Remifentanil

injectable solution, 0.5 microgramme/Kg for 30 seconds following by a continuous dose of 0.1 microgramme/kg/minute

Group Type: ACTIVE_COMPARATOR

Remifentanil

Intervention Type: DRUG

Placebo

injectable solution 0.9% for the end of surgery

Group Type: PLACEBO_COMPARATOR

sodium chloride 0,9%

Intervention Type: DRUG

Interventions

Remifentanil

Intervention Type: DRUG

sodium chloride 0,9%

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Patient over 18 years
• Single pregnancy with an indication for cesarean section under general anesthesia context of prematurity (<37SA)
• Patient informed and written consent for participation in this research signed
• Affiliation to social security

Parents informed and written consent signed by the father and mother for the participation in this research by the child (unless a parent no longer has parental authority)

• Vaginal Delivery
• Mother pathology requiring the use of an opioid during induction
• Severe Preeclampsia
• More than 14 weeks between the information and the inclusion
• Patient under guardianship

Fetal pathology diagnosed in the prenatal period involving the prognosis of the child

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

University Hospital, Rouen

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

TOURREL Fabien, MD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Rouen

Locations

CHU de Rouen

Rouen, , France

Countries

France

References

Chollat C, Tourrel F, Houivet E, Gillet R, Verspyck E, Lecointre M, Marret S, Compere V. Low-Dose Remifentanil in Preterm Cesarean Section with General Anesthesia: A Randomized Controlled Trial. Paediatr Drugs. 2024 Jan;26(1):71-81. doi: 10.1007/s40272-023-00591-w. Epub 2023 Sep 15.

Reference Type: DERIVED

PMID: 37713021 (View on PubMed)

Other Identifiers

2012/175/HP

Identifier Type: -

Identifier Source: org_study_id