Remifentanil at induction of general anesthesia for cesarean section: Double blind, randomized clinical trial
Article Sidebar
Main Article Content
Introduction: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of remifentanil during cesarean section surgery.
Methods: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia (ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either and intravenous bolus of 0.5 µg/kg remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups.
Results: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the remifentanil group as compared with the control group (p<0.05). There were no significant differences regarding heart rate between groups at any time (p>0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxan administration.
Conclusion: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.
1- Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia. 2003; 58(11): 1114-8.
2- Kan RE, Hughes SC, Rosen MA, Kessin C, Preston PG, Lobo EP. Intravenous remifentanil: placental transfer, maternal and neonatal effects. Anesthesiol. 1998; 88(6): 1467-74.
3- Ngan Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB, Ng FF. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial. Anesthesiol. 2006; 104(1): 14-20.
4- Prakash N, McLeod T, Gao Smith F. The effects of remifentanil on haemodynamic stability during rigid bronchoscopy. Anaesthesia. 2001; 56(6): 576-80.
5- Orme RM, Grange CS, Ainsworth QP, Grebenik CR. General anaesthesia using remifentanil for caesarean section in parturients with critical aortic stenosis: a series of four cases. Int J Obstet Anesth. 2004; 13(3): 183-7.
6- Macfarlane AJ, Moise S, Smith D. Caesarean section using total intravenous anaesthesia in a patient with Ebstein’s anomaly complicated by supraventricular tachycardia. Int J Obstet Anesth. 2007; 16(2): 155-9.
7- Amini S, Yaghmaei M. The use of remifentanil in general anesthesia for cesarean section in a parturient with severe mitral stenosis and pulmonary edema. Middle East J Anesthesiol. 2010; 20(4): 585-8.
8- Bilehjani E, Kianfar AA, Toofan M, Fakhari S. Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathya case report. Middle East J Anesthesiol. 2008; 19(5): 1141-9
9- Miyawaki Y, Yumiba T, Asaga T, Taie S, Shirakami G. Remifentanil is useful for cardiovascular stability during cesarean delivery in a parturient with Marfan’s syndrome. Masui. 2010; 59(10): 1305-7.
10- Imarengiaye C, Littleford J, Davies S, Thapar K, Kingdom J. Goal oriented general anesthesia for Cesarean section in a parturient with a large intracranial epidermoid cyst. Can J Anaesth. 2001; 48(9): 884-9.
11- Richa F, Yazigi A, Nasser E, Dagher C, Antakly MC. General anesthesia with remifentanil for Cesarean section in a patient with HELLP syndrome. Acta Anaesthesiol Scand. 2005; 49(5): 418-20.
12- Carvalho B, Mirikitani EJ, Lyell D, Evans DA, Druzin M, Riley ET. Neonatal chest wall rigidity following the use of remifentanil for cesarean delivery in a patient with autoimmune hepatitis and thrombocytopenia. Int J Obstet Anesth. 2004; 13(1): 53-6.
13- Draisci G, Valente A, Suppa E, Frassanito L, Pinto R, Meo F, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal wellbeing: a randomized trial. Int J Obstet Anesth. 2008; 17(2): 130-6.
14- Yoo KY, Jeong CW, Park BY, Kim SJ, Jeong ST, Shin MH, et al. Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia. Br J Anaesth. 2009; 102(6): 812-9.
15- Van de Velde M, Teunkens A, Kuypers M, Dewinter T, Vandermeersch E. General anaesthesia with target controlled infusion of propofol for planned caesarean section: maternal and neonatal effects of a remifentanil-based technique. Int J Obstet Anesth. 2004; 13(3): 153-8.
16- Volmanen P, Akural EI, Raudaskoski T, Alahuhta S. Remifentanil in obstetric analgesia: a dose-finding study. Anesth Analg. 2002; 94(4): 913-7.
17- Glass PSA, Hardman D, kamiyama Y, Quil TJ, Marton G, Donn KH, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: Remifentanil. Anesth Analg. 1993; 77(5): 1031-40.
18- Minto CF, Schnider TW, Short TG, Gregg KM, Gentilini A, Shafer SL. Response surface model for anesthetic drug interactions. Anesthesiol. 2000; 92 (6): 1603-16.
19- McCarroll CP, Paxton LD, Elliott P, Wilson DB. Use of remifentanil in a patient with peripartum cardiomyopathy requiring Caesarean section. Br J Anaesth. 2001; 86(1): 135-8.
20-Sykes GS, Johnson P, Ashworth F, Molloy PM , Gu W, Stirrat GM, et al. Do Apgar scores indicate asphyxia? Lancet. 1982; 1(8270): 494-6
Downloads
- Seyed Mokhtar Esmaeilnejd Ganji, Behnam Baghianimoghadam, Flexor Digitorum Superficialis and Flexor Digitorum Profundus with separated sheaths , Colombia Medica: Vol. 46 No. 4 (2015)
Accepted 2013-04-04
Published 2013-05-31
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use