[Remifentanil bolus for cesarean section in high-risk patients: study of 12 cases].
OBJECTIVE
To evaluate the utility and safety of remifentanil for hemodynamic control during cesarean section in high-risk patients ineligible for spinal anesthesia.


METHODS
One minute before induction we injected a bolus of 1 microg x kg(-1) of remifentanil, followed by propofol (2.5 mg x kg(-1)), succinylcholine (1 mg x kg(-1)), cisatracurium, sevoflurane in oxygen and nitrous oxide, and fentanyl (5 microg x kg(-1)) after clamping the umbilical cord. We recorded maternal hemodynamic variables, pulse oximetry, capnography, bispectral index, and presence of muscular rigidity. In the neonate we assessed fetal wellbeing, weight, and requirement for naloxone. Hemodynamic stability was defined as no more than 15% variation in arterial pressure with respect to baseline.


RESULTS
Twelve patients undergoing surgery because of placenta abruptio, subarachnoid hemorrhage, HELLP syndrome, or preeclampsia were enrolled. Hemodynamic variables were consistently stable during surgery in all patients. No cases of neonatal rigidity were noted and there was no need for naloxone. The mean Apgar score was 6.42 (1.5) at 1 minute and 8.42 (0.9) at 5 minutes.


CONCLUSIONS
Bolus injection of 1 microg x kg(-1) of remifentanil may be useful for maintaining maternal hemodynamic stability in high-risk obstetric cases. Given the risk of neonatal depression, this resource should be used selectively and the means for neonatal resuscitation should be available.
Palacio
F J
FJ
Servicio de Anestesiología y Reanimación, Hospital Maternal La Paz. Madrid.
Ortiz-Gómez
J R
JR
Fornet
I
I
López
M A
MA
Morillas
P
P
D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005333:Fetus / Q000187:drug effects / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D008738:Methyl Ethers / Q000008:administration & dosage; D009127:Muscle Rigidity / Q000139:chemically induced; D009270:Naloxone / Q000627:therapeutic use; D009609:Nitrous Oxide / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications; D018566:Pregnancy, High-Risk; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D012151:Resuscitation; D012189:Retrospective Studies; D000077149:Sevoflurane; D013390:Succinylcholine / Q000008:administration & dosage
D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D001279:Atracurium; D009270:Naloxone; D000077149:Sevoflurane; D013390:Succinylcholine; D009609:Nitrous Oxide; D000077208:Remifentanil; C101584:cisatracurium; D005283:Fentanyl; D015742:Propofol