A dose–response study of remifentanil for attenuation of the hypertensive response to laryngoscopy and tracheal intubation in severely preeclamptic women undergoing caesarean delivery under general anaesthesia

Yoo, Kyung Yeon; Kang, Dong Ho; Jeong, Hye Jin; Jeong, Chaehwan; Choi, Young-Kyun; Lee, J.

doi:10.1016/j.ijoa.2012.09.010

Cited by 43 publications

(23 citation statements)

References 37 publications

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“…While group R showed no significant changes all over the surgery in the hemodynamics. These desirable effects of remifentanil on hemodynamic stability has been shown in previous studies using different doses of remifentanil [24][25][26][27].…”

Section: Discussionsupporting

confidence: 62%

The Effects of Dexmedetomidine or Remifentanil Continuous Infusion on End- Tidal Sevoflurane Concentration in Patients Undergoing Laparoscopic Cholecestectomies, Monitored by Bispectral Analysis

Mogahed¹,

Anwar²

2017

J Anesth Clin Res

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Background and Objective: Owing to the hemodynamic response to pneumoperitoneum, laparoscopic is not devoid of risk; adjuvants have been used to decrease the dose of volatile agents and their side effects and to blunt the hemodynamic response. This study was designed to compare the effect of dexmedetomidine and remifentanil on sevoflurane expired fraction concentration (EF sevo) in general anesthesia, monitored by BIS. Hemodynamic response, postoperative recovery profile, analgesic requirements and PONV were also recorded.

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Section: Discussionsupporting

confidence: 62%

The Effects of Dexmedetomidine or Remifentanil Continuous Infusion on End- Tidal Sevoflurane Concentration in Patients Undergoing Laparoscopic Cholecestectomies, Monitored by Bispectral Analysis

Mogahed¹,

Anwar²

2017

J Anesth Clin Res

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“…A hypothetical explanation of different results in published studies could be the existence of genetic polymorphism of the placenta transporting system glycoprotein P (multidrug resistance gene 1, MDR1) and polymorphism of μ-receptors and then divergent transfer of remifentanil into the foetal circulation [ 21 , 22 ]. Another reason for relatively higher incidence of respiratory depression in our study may also be shorter time of foetal delivery (4.0 min induction-to-delivery time) compared to some other centres [ 20 , 23 , 24 ]. We may hypothesize that remifentanil with its half-life of 3–10 minutes was not completely eliminated at the time of delivery.…”

Section: Discussionmentioning

confidence: 67%

“…We may hypothesize that remifentanil with its half-life of 3–10 minutes was not completely eliminated at the time of delivery. This could explain why Yoo et al [ 24 ] found no significantly higher depression rate, even with a dose of 1.25 μg/kg. It should be noted that they reported interval to delivery approximately 10 minutes, which is potentially longer than expected effect of remifentanil.…”

Section: Discussionmentioning

confidence: 98%

Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial

et al. 2015

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BackgroundRemifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn.MethodsUsing a double-blinded randomized design, a total of 151 parturients undergoing caesarean delivery under general anaesthesia were randomized into two groups – 76 patients received a bolus of remifentanil prior to induction, while 75 patients were assigned to the control group. Remifentanil 1 μg/kg was administered 30 seconds before the standard induction of general anaesthesia. The primary outcome measure was an assessment of neonatal adaptation using the Apgar score, while secondary outcomes included the need for respiratory support after delivery and differences in umbilical blood gas analysis (Astrup).ResultsThe incidence of lower Apgar scores between 0 and 7 was significantly higher in the remifentanil group at one minute (25% vs. 9.3% of newborns, p = 0.017); whilst at five minutes and later no Apgar score differences were observed. There was no difference in the need for moderate (nasal CPAP) or intensive (intubation) respiratory support, but significantly more neonates in the remifentanil group required tactile stimulation for breathing support (21% vs. 7% of newborns, p = 0.017). There was no difference in the parameters from umbilical cord blood gas analysis between the groups.ConclusionAt a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short.Trial registrationClinicalTrials.gov: NCT01550640.

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“…While not specifically addressed by any of the guidelines, remifentanil at doses of [ 1 lgÁkg -1 was found reliable in attenuating the response to laryngoscopy while producing hypotension in only a small number of cases. 34,35 The hemodynamic response to vasopressors in these patients may be exaggerated, and hypotension should be easily corrected using small incremental doses of phenylephrine or ephedrine without adverse fetal effects. 5,27 The safety and neonatal consequences of prophylactic phenylephrine infusion, now part of routine prevention of post-spinal hypotension, have not been assessed in preeclamptic women.…”

Section: Anesthesia For Operative Deliverymentioning

confidence: 99%

“…Bien que cet agent ne soit pas mentionné spécifiquement dans les directives, il a été démontré que le rémifentanil, à des doses [ 1 lgÁkg -1 , était fiable pour atténuer la réponse à la laryngoscopie tout en ne provoquant d'hypotension que dans un petit nombre de cas. 34,35 La réponse hémodynamique aux vasopresseurs des patientes prééclamptiques peut être exagérée, et l'hypotension devrait être facile à corriger à l'aide de petites doses incrémentielles de phényléphrine ou d'éphédrine sans complications pour le foetus. 5,27 L'innocuité et les conséquences pour le nouveau-né d'une perfusion prophylactique de phényléphrine, qui fait désormais partie de la prévention usuelle de l'hypotension post-rachidienne, n'ont pas encore été évaluées chez les femmes présentant une prééclampsie.…”

Section: L'anesthésie Pour L'accouchement Opératoireunclassified

Hypertensive disorders of pregnancy

Sjaus

McKeen

George

2016

Can J Anesth/J Can Anesth

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Purpose In this continuing professional development module, we review recent Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines for the classification and diagnosis of hypertensive disorders of pregnancy (HDP) as well as review the clinical features, laboratory investigations, and outcomes of HDP. We explore the evidence for anesthetic management and prevention of end-organ damage in women with HDP and describe the role and contribution of anesthesiologists as part of a multidisciplinary care team. Principal findings Hypertensive disorders of pregnancy can have variable presentations with clinical signs and symptoms that often do not correlate with the underlying severity and progression of the disease. Failure of timely diagnosis and treatment contributes significantly to adverse maternal (neurologic complications, pulmonary edema, and postpartum hemorrhage) and neonatal (respiratory and neurologic complications and stillbirth) outcomes. In the Canadian context, improvements in medical care have led to better maternal and neonatal outcomes. Timing of delivery is crucial in balancing maternal risks and fetal benefits of ongoing pregnancy. Evidence-based SOGC guidelines regarding diagnosis and management of HDP address many aspects of clinical care relevant to anesthesiologists, who have an important role in the multidisciplinary care team. Conclusions Hypertensive disorders of pregnancy are on the rise worldwide, and this trend is expected to continue. The major contributors to maternal mortality are failure to recognize HDP promptly or to treat the condition adequately. It is essential that anesthesiologists understand the disease process and acquire knowledge of the guidelines governing current obstetrical care in order to provide evidence-based multidisciplinary quality care to these patients. Anesthetic management helps prevent potentially deleterious maternal and fetal outcomes. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to: 123Can J Anesth/J Can Anesth (2016) 63:1075-1097 DOI 10.1007 neuraxial analgesia/anesthesia, vasopressors, and uterotonics in women with HDP. 6. Describe the assessment and preparation of a parturient for urgent Cesarean delivery under general anesthesia with anesthetic, obstetrical, and fetal considerations. 7. Describe the postpartum needs of women with preeclampsia. Overview and incidenceHypertensive disorders of pregnancy (HDP) can have multifaceted symptomatology, and can range in severity from a benign disorder that presents in the third trimester to a volatile multisystem disorder that presents early (\ 34 weeks' gestation) and evolves rapidly to severe maternal end-organ dysfunction and fetal compromise. Worldwide, HDP affect 3-8% of pregnancies and are significant contributors to maternal and neonatal morbidity and mortality.1 In Canada, the rates of HDP have remained relatively stable over the preceding decade (around 5%). 2,3Hypertension without proteinuria, along with...

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A dose–response study of remifentanil for attenuation of the hypertensive response to laryngoscopy and tracheal intubation in severely preeclamptic women undergoing caesarean delivery under general anaesthesia

Cited by 43 publications

References 37 publications

The Effects of Dexmedetomidine or Remifentanil Continuous Infusion on End- Tidal Sevoflurane Concentration in Patients Undergoing Laparoscopic Cholecestectomies, Monitored by Bispectral Analysis

The Effects of Dexmedetomidine or Remifentanil Continuous Infusion on End- Tidal Sevoflurane Concentration in Patients Undergoing Laparoscopic Cholecestectomies, Monitored by Bispectral Analysis

Neonatal effect of remifentanil in general anaesthesia for caesarean section: a randomized trial

Hypertensive disorders of pregnancy

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