doiSerbia

The effect of remifentanil used during caesarean section on maternal hemodynamics and neonatal outcome - comparison of two dosing regimens

Kutlešić Marija S. (Niš University Clinical Centre, Clinic of Anesthesiology, Niš, Serbia + Niš University Clinical Centre, Clinic of Gynaecology and Obstetrics, Niš, Serbia)
Pavlović Svetlana (Niš University Clinical Centre, Clinic of Anesthesiology, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, Serbia)
Kutlešić Ranko M. (Niš University Clinical Centre, Clinic of Gynaecology and Obstetrics, Niš, Serbia + University of Niš, Faculty of Medicine, Niš, Serbia)

Introduction/Objective. To present and compare maternal and neonatal effects of two remifentanil dosing regimens, used during induction-delivery period of elective caesarean section in attempt to attenuate maternal cardiovascular response to surgical stress. Methods. Seventy-seven ASA I-II parturients were randomly divided into three groups and received the following: A – 1 μg/kg remifentanil immediately before the induction to anesthesia followed by 0.15 μg/ kg/min infusion, interrupted after skin incision; B – 1 μg/kg remifentanil bolus immediately before the induction; C – no remifentanil until delivery. Hemodynamic (blood pressure, heart rate) and bispectral index changes after endotracheal intubation, skin incision, peritoneal incision and delivery, intraoperative anesthetics consumption and neonatal outcome have been compared between the groups. Results. Hemodynamic response to intubation was significantly attenuated (p < 0.001) in groups A and B compared to C. Hemodynamic response to skin incision, peritoneal incision and delivery was significantly attenuated in group A compared to B and C. Thiopentone dose in groups A and B was lower than in group C (p < 0.001); sevoflurane and remifentanil consumption was less in group A compared to B and C (p < 0.001). Apgar scores at 1st minute were ≥ 8 in all neonates, with no differences in neonatal heart rate, oxygen saturation and umbilical blood gas values (all within normal range). Conclusion. 1 μg/kg remifentanil bolus followed by 0.15 μg/kg/min stopped after skin incision, successfully blunted maternal hemodynamic stress response throughout whole induction-delivery period, reduced anesthetic consumption, without affecting neonatal outcome, so it can be considered effective as well as safe to use during induction-delivery period of caesarean section.

Keywords: anesthesia, obstetrical, remifentanil