Efficacy and safety of remifentanil for analgesia in cesarean delivery

Abstract

Background:This study aimed to assess the efficacy and safety of remifentanil as a general anesthetic during cesarean delivery.Material and Methods:Fifty women with singleton pregnancies undergoing cesarean delivery were randomly divided into intervention and control groups, each group containing 25 subjects. Participants in the intervention group received remifentanil (infused at 2 μg/kg/h), whereas subjects in the control group were given dexmedetomidine (infused at 0.4 μg/kg/h). Outcome measurements included mean arterial blood pressure (MAP), heart rate (HR), bispectral index (BIS), Apgar scores at 1 and 5 minutes, and the pH, PCO2, PO2, and base excess (BE) of umbilical venous and arterial blood.Results:Forty-four participants completed the study. Patients in the intervention group did not experience greater effect and safety than those in the control group (P > .05), although MAP and BIS values decreased significantly immediately before laryngoscopy (P < .05). In addition, BIS values were reduced significantly at the time of skin incision, at uterine incision, and immediately after fetal delivery when compared with baseline values in both groups (P < .01).Conclusion:This study concluded that remifentanil and dexmedetomidine exhibited similar efficacy and safety during general anesthesia for cesarean delivery.

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

“…Earlier infusion interruption than in previous studies (after skin incision instead of at peritoneal incision or even at delivery) should leave enough time for remifentanil redistribution and metabolism in fetal circulation, thus diminishing the probability of neonatal respiratory depression. Hemodynamic variables measured after the intubation in groups A and B were significantly lower than in group C. Therefore, both regimens attenuated cardiovascular response to endotracheal intubation, which is in accordance with previous reports [4,9,[12][13][14][15][16]. The next measurement, performed after skin incision, already showed the difference: the significant difference in SAP, DAP, MAP, and HR between groups B and C disappeared, but persisted in A compared to C. At the time of peritoneal incision and at the delivery measured hemodynamic variables were significantly lower in group A compared to both C and B group.…”

“…In studies reporting the use of remifentanil during the I-D period dosing regimens were different; hemodynamic stability was often achieved at the expense of neonatal respiratory depression [2,4,[6][7][8][9][11][12][13][14][15][16]. In the present study, we investigated the effects of two remifentanil dosing regimens, used during the I-D period, on maternal hemodynamics and neonatal outcome in attempt to find the best compromise between the attenuation of maternal stress response and avoidance of neonatal adverse effects.…”

Effect of intravenous dexmedetomidine and remifentanil on neonatal outcomes after caesarean section under general anaesthesia

“…Four studies with 210 patients reported blood pH values for the umbilical artery and vein 28,30–32 . The combined results showed no evidence of a difference between the remifentanil (7.30; 95% CI, 7.26 to 7.34) and dexmedetomidine (7.30; 95% CI, 7.27 to 7.33) groups for pH values of the umbilical arterial blood: WMD: 0.00; −0.02 to 0.02; τ 2 = 0.00 (Fig.…”

“…In all the studies included in this review, dexmedetomidine and remifentanil were given via continuous infusion. In four studies, both drugs were given as a bolus followed by a continuous infusion, 28,29,31,32 and in one study, the drugs were administered using continuous infusion alone 30 . However, some other studies, not in our review, used a single bolus dose without continuous infusion 39–43 .…”

“…Four studies had only remifentanil and dexmedetomidine groups but one study 28 also included a control group. Three studies included healthy term or near-term parturients, 28,31,32 and two studies included only severely preeclamptic patients. 29,30 The primary outcome of four studies was maternal mean arterial pressure, [29][30][31][32] whereas one study did not specify the primary outcome.…”