Impact of two different doses regimen of remifentanil in cases of cesarean section on maternal and neonatal conditions

ABSTRACT

Forty healthy full term pregnant women scheduled for elective cesarean section were randomly allocated into 2 equal groups, 20 women each. Induction of anesthesia was done by remifentanil, thiopental and succinylcholine in a rapid sequence fashion. After induction, patients received one of two doses of continues infusion, either 0.1 mug/kg/min [group I] or 0.25 mug/kg/min [group II]. Anesthesia was maintained by isoflurane 0.5% in oxygen and atracurium for muscle relaxation. Maternal vital signs [heart rate, mean arterial blood pressure, oxygen saturation and any side effects] were recorded. Neonatal evaluation including Apgar score at one and five minutes and umbilical cord blood gas analysis were estimated after delivery. Remifentanil infusion was stopped at the last of skin closure and time response to verbal stimuli and extubation time were recorded. Maternal and neonatal outcome was satisfactory in both groups. As regards Apgar scores and umbilical cord blood gas analysis, there was no significant difference between the two groups. Neither parturient women nor their babies required naloxone. In spite of the fact that there was a significant difference in remifentanil dose between the two groups, the time response to verbal stimuli and tracheal extubation were similar. However, hypotension was reported in 45% of patients in group II and no one in group I. Remifentanil appears to be safe and effective for mother and baby when used as a part of an opioid-based general anesthesia for cesarean section