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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

RéSUMé: OBJECTIF: L'absence de recommandations fondées sur des données probantes pour les accouchements par césarienne sous anesthésie générale peut entraîner une variabilité de la pratique et une morbidité, en particulier en ce qui concerne l'utilisation d'opioïdes. L'objectif de cette étude était de décrire la pratique pour les accouchements par césarienne réalisés sous anesthésie générale ainsi que d'identifier les facteurs prédictifs d'une utilisation d'opioïdes lors de l'induction de l'anesthésie et la nécessité d'une réanimation néonatale. MéTHODE: Nous avons mené une étude de cohorte historique monocentrique. Nous avons inclus toutes les parturientes adultes qui ont accouché par césarienne sous anesthésie générale entre le 1er janvier 2012 et le 31 décembre 2016. Nous avons exclu les patientes ayant reçu une anesthésie générale après l'accouchement ou ayant subi une mort fœtale intra-utérine connue. Nous avons recueilli des données sur l'utilisation de médicaments anesthésiques, les comorbidités maternelles, la réanimation néonatale et les complications anesthésiques. Nous avons utilisé des modèles de régression logistique pour identifier les prédicteurs d'une utilisation d'opioïdes lors de l'induction de l'anesthésie et les prédicteurs de réanimation néonatale. RéSULTATS: Deux cent trois patientes ont été incluses. Le propofol était le principal agent d'induction (n = 195), 201 patientes ont reçu des bloqueurs neuromusculaires et 67 ont reçu des opioïdes. Aucun facteur maternel, y compris les troubles hypertensifs de la grossesse (rapport de cotes [RC], 1,94; intervalle de confiance [IC] à 95 %, 0,96 à 3,95; P = 0,06), n'était un prédicteur d'utilisation d'opioïdes au moment de l'induction de l'anesthésie. Aucune différence statistique n'a été détectée entre les groupes d'administration d'opioïdes, à l'exception de l'indication de césarienne, la prééclampsie étant le principal contributeur. Un âge gestationnel bas (RC, 0,75; IC 95 %, 0,65 à 0,87; P = 0,002) était le seul prédicteur de réanimation néonatale. CONCLUSION: Les troubles hypertensifs de la grossesse n'étaient pas des prédicteurs de l'utilisation d'opioïdes et l'utilisation d'opioïdes n'était pas un prédicteur de réanimation néonatale. Cela suggère que les opioïdes pourraient être utilisés pour des indications maternelles.

Laboratory-based toxicological assessments of new insecticides on mortality and fecundity of Neoseiulus fallacis (Acari: Phytoseiidae).

Neoseiulus fallacis (Garman) is one of the most abundant predatory phytoseid in deciduous fruit orchards under an integrated pest management (IPM) regimen in eastern North America. Laboratory studies using N. fallacis, and the 'modified excised leaf disc method' identified four insecticides out of six, that would require second-tier field studies before inclusion in an IPM program for deciduous orchards. The overall egg mortality caused by flubendiamide, chlorantraniliprole, chlothianidin, novaluron, Spinetoram, and spirotetramat ranked from 0 to 37.6%. Larval mortality caused by spirotetramat, spinetoram, novaluron, and chlothianidin ranged from 100 to 78.3%, respectively. Chlorantraniliprole and flubendiamide were virtually nontoxic to larvae. Spinetoram, chlothianidin, and spirotetramat caused 100, 61.4, and 40.2% mortality of adult N. fallacis, respectively. Spirotetramat and chlothianidin significantly reduced fecundity, whereas novaluron, flubendiamide, and chlorantraniliprole had no such adverse effect for the duration of the study (168 h). Chlorantraniliprole and flubendiamide do not require further second tier field studies and may be included in deciduous orchard IPM programs. Spirotetramat is toxic to several growth stages but it has a very short residual activity, and along with novaluron, which is toxic only to larvae, should be evaluated in second-tier field studies. Clothianidin and spinetoram should be evaluated in second-tier field studies only if alternatives are unavailable.

Optimization of a Mass Trapping Method against the Striped Cucumber Beetle Acalymma vittatum in Organic Cucurbit Fields.

The striped cucumber beetle (SCB) Acalymma vittatum (F.) (Coleptera: Chrysomelidae) is a prime problem in North American cucurbit crops. While certain chemical pesticides efficiently control SCB in conventional cucurbit fields, alternative solutions are required due to the ever-evolving regulations on pesticides. For organic producers, very few control methods exist. A novel mass trapping method demonstrates the potential of controlling SCBs using floral-based semiochemical baited traps in cucurbit crops. The goals of this study were to (1) determine whether baited traps capture more SCBs than unbaited ones, and (2) optimize the trapping method by comparing different trap types and different commercially available attractants to maximize SCB captures while minimizing non-target species captures. The results of a first experiment showed that baited traps captured significantly more SCBs than unbaited ones. Baited traps also captured significantly more bees and hoverflies than unbaited ones. In a second experiment these unwanted captures were drastically reduced by using traps with ten 4 mm in diameter holes per side. Finally, a third experiment demonstrated that the attractant 40CT313 was the most efficient at capturing SCB compared to other tested lures. Overall, the optimized mass trapping technique demonstrated a potential to effectively control SCB populations in organic cucurbit crops.

A laboratory assessment of the toxic attributes of six 'reduced risk insecticides' on Galendromus occidentalis (Acari: Phytoseiidae).

The modified excised leaf disc method was used to measure the effects of six insecticides on eggs, larvae, adults, and female fecundity of Galendromus occidentalis (Nesbitt) in a 'worst case laboratory exposure'. This study identified insecticides that would be recommended for tier II field evaluations for an integrated pest management program. Commercially formulated insecticides were applied with a thin-layer chromatography sprayer adjusted to 10.34 kPa (1.5 psi), at the recommended label concentrations in Canada. LC(50) values were estimated from aliquots above and below that concentration. Spinetoram and spirotetramat were toxic at label concentrations. The label concentration for spinetoram was 34.3-fold the LC(50) estimate (0.006 gL(-1)) and for spirotetramat the label concentration was 7.7-fold the LC(50) estimate (0.03 gL(-1)). Clothianidin was considerably less toxic and the label concentration was 0.15-fold the LC(50) estimate (2.29 gL(-1)). Estimates of LC(50) for novaluron and chlorantraniliprole could not be established. Both materials showed slight toxicity to at least one growth stage of the predator. Novaluron, clothianidin and chlorantraniliprole should be evaluated in the field for compatibility in IPM programs. Flubendiamide was harmless to all growth stages and it is recommended for inclusion in IPM programs without additional tier II field evaluations. Field evaluations with spinetoram and spirotetramat should be pursued only if alternatives are unavailable.