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A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neontal effects

[Une seule dose de fentanyl et de midazolam administrée avant la césarienne n’a pas ďeffet néonatal]

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Analgesia and sedation, routinely used as adjunct medications for regional anesthesia, are rarely used in the pregnant patient because of concerns about adverse neonatal effects. In an effort to obtain more information about maternal analgesia and sedation we studied neonatal and maternal effects of iv fentanyl and midazolam prior to spinal anesthesia for elective Cesarean section.


In this double-blinded, randomized, placebo-controlled trial, 60 healthy women received either a combination of 1 µg·kg-1 fentanyl and 0.02 mg·kg-1 midazolam intravenously or an equal volume of iv saline at the time of their skin preparation for a bupivacaine spinal anesthetic. Sample size was based on a non-parametric power analysis (power > 0.80 and alpha = 0.05) for clinically important differences in Apgar scores. Fetal outcome measures included Apgar scores, continuous pulse oximetry for three hours, and neurobehavioural scores. Maternal outcomes included catecholamine levels, and recall of anesthesia and delivery.


There were no between-group differences of neonatal outcome variables (Apgar score, neurobehavioural scores, continuous oxygen saturation). Mothers in both groups showed no difference in their ability to recall the birth of their babies.


Maternal analgesia and sedation with fentanyl (1 µg·kg-1) and midazolam (0.02 mg·kg-1) immediately prior to spinal anesthesia is not associated with adverse neonatal effects.



Ľanalgésie et la sédation, complément habituel à ľanesthésie régionale, sont rarement utilisées chez la femme enceinte parce qu’on craint les effets néonatals indésirables. Pour en savoir davantage sur ľanalgésie et la sédation de la mère, nous avons étudié les effets sur la mère et ľenfant du fentanyl et du midazolam iv administrés avant la rachianesthésie pour césarienne.


Pour ľétude randomisée, à double insu et contrôlée contre placebo, 60 femmes en santé ont reçu une combinaison intraveineuse de 1 µg·kg-1 de fentanyl et 0,02 mg·kg-1 de midazolam ou un volume égal de solution saline iv au moment de préparer à la rachianesthésie avec bupivacaine. La taille de ľéchantillon reposait sur une analyse de puissance non paramétrique (puissance > 0,80 et alpha = 0,05) pour des différences cliniquement importantes ďindices ďApgar. Les mesures de ľévolution du fœtus comprenaient ľindice ďApgar, la sphygmo-oxymétrie continue pendant trois heures et les scores neurocomportementaux. Ľévaluation de la mère incluait les niveaux de catécholamine et la présence de souvenir de ľanesthésie et de ľaccouchement.


Il n’y a pas eu de différence intergroupe des variables mesurées chez le nouveau-né (indice ďApgar, comportement neurologique, mesure continue de la saturation en oxygène). Les mères des deux groupes ont montré la même capacité à se rappeler la naissance de leurs enfants.


Ľanalgésie et la sédation maternelles avec du fentanyl (1 µg·kg-1) et du midazolam (0,02 mg·kg-1) administrées immédiatement avant la rachianesthésie ne sont pas associées à des effets néonatals indésirables.


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Correspondence to Michael A.Frölich or David J. Burchfield or Tammy Euliano or Donald Caton.

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A.Frölich, M., Burchfield, D.J., Euliano, T. et al. A single dose of fentanyl and midazolam prior to Cesarean section have no adverse neontal effects. Can J Anesth 53, 79–85 (2006).

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  • Fentanyl
  • Midazolam
  • Spinal Anesthesia
  • Apgar Score
  • Neonatal Intensive Care Unit Admission