The objective of this research is prevention of parturients’
exaggerated cardiovascular response to endotracheal intubation and
surgical incision during induction-delivery period of caesarean
section, when anesthetics doses are reduced in order to avoid
neonatal respiratory depression. We discuss risk factors for the
development of exaggerated hemodynamic stress response as well as
pharmacotherapeutic possibilities for its attenuation, and than focus
on remifentanil, its pharmacokinetics, pfarmacodynamics, clinical
use and its role in preconditioning and protection against oxidative
stress. Due to rapid onset of action and short context-sensitive
halftime of only 3 min, remifentanil could be the drug of choice in a
situation where intensive but short analgesia without residual effects
is desirable.
Seventy seven ASA status I-II parturients were included in
this prospective, randomized study and divided in following groups:
A – 31 parturient who received 1 μg/kg remifenta...nil bolus just before
the induction to anesthesia, followed by 0.15 μg/kg/min infusion,
interrupted after the skin incision; B - 27 parturients who received
only 1 μg/kg remifentanil bolus before the induction to anesthesia; C
- 19 parturients who did not receive remifentanil until the delivery.
For induction and maintenance of anesthesia thiopenton and
sevoflurane were used; after the delivery all parturients received
remifentanil. Hemodynamic variables, BIS values, intraoperative
anesthetic and remifentanil consumption, intubating and extubating
conditions, postoperative sedation and pain scores were measured
and compared between groups. Parameters of oxidative stress and
adenosine deaminase activity were measured in parturients venous
and umbilical venous blood samples. Neonatal Apgar scores, heart
rate, hemoglobin oxygen saturation and umbilical arterial and venous
gas analysis were determined.
Original remifentanil dosing regimen, applied in group A,
significantly attenuated hemodynamic stress response to intubation
and surgical incision, provided excellent intubating conditions,
reduced anesthetics and remifentanil consumption and reduced the
level of lipid peroxidation without adversely affecting neonatal
outcome, so it can be considered safe and effective to use in
vulnerable induction to delivery period of caesarean section.
