You have attempted to top up an epidural for a category one caesar for fetal distress. The block seems adequate but once the surgeons enter the abdomen your patient complains of significant pain and you decide to convert to general anaesthesia. You perform an RSI with propofol and rocuronium. After intubation she has a heart rate of 130 and an NIBP of 155 / 90. Your registrar asks “why didn’t we give her any opioid?” and you patiently explain that we avoid opioids until after delivery because we don’t want them to cross the placenta and to cause respiratory depression in the neonate……………but is this always true???

Hi everyone,

Join Jacob and I as we discuss the recent literature surrounding this topic. What is the evidence? What about the short acting opioids such as alfentanil & remifentanil? What are the advantages / disadvantages of using an opioid and what are the downsides of not using opioids?

References

Best practice in obstetric general anaesthesia: an umbrella review of pharmacological strategies for induction of general anaesthesia. Anaesthesia, 81: 1269-1280. 2026. https://doi.org/10.1111/anae.70214

Induction opioids for caesarean section under general anaesthesia: a systematic review and meta-analysis of randomised controlled trials International Journal of Obstetric Anesthesia, 2019; 40, 4-13

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