Efekat remifentanila na hemodinamiku, metabolizam adenozina i oksidativni stres toko carskog reza

Abstract

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 remifentanil 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.