Effects of remifentanil on cardiovascular and bispectral index responses to endotracheal intubation in severe pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia.
BACKGROUND
We examined the effects of remifentanil on cardiovascular and bispectral index (BIS) responses to tracheal intubation and neonatal outcomes in pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia.


METHODS
Forty-two women with severe pre-eclampsia were randomly assigned to receive either remifentanil 1 microg kg(-1) (n=21) or saline (n=21) over 30 s before induction of anaesthesia using thiopentone 4 mg kg(-1) and suxamethonium 1.5 mg kg(-1). Mean arterial pressure (MAP), heart rate (HR) and BIS values as well as plasma catecholamine concentrations were measured. Neonatal effects were assessed using Apgar scores and umbilical cord blood gas analysis.


RESULTS
Induction with thiopentone caused a reduction in MAP and BIS in both remifentanil and control groups. Following the tracheal intubation MAP and HR increased in both groups, the magnitude of which was lower in the remifentanil group. BIS values also increased, of which magnitude did not differ between the groups. Norepinephrine concentrations increased significantly following the intubation in the control, while remained unaltered in the remifentanil group. The neonatal Apgar scores at 1 min were significantly lower in the remifentanil group than in the control. However, Apgar scores at 5 min, and umbilical artery and vein blood gas values were similar between the groups.


CONCLUSIONS
These results suggest that a single bolus of 1 microg kg(-1) remifentanil effectively attenuates haemodynamic but not BIS responses to tracheal intubation in pre-eclamptic patients undergoing Caesarean delivery under general anaesthesia. However, its use was associated with maternal hypotension and neonatal respiratory depression requiring resuscitation.
Department of Anaesthesiology, National University Medical School, 8 Hak-dong, Gwangju 501-190, South Korea. kyyoo@jnu.ac.kr
K Y
KY
Yoo
C W
CW
Jeong
B Y
BY
Park
S J
SJ
Kim
S T
ST
Jeong
M H
MH
Shin
J
J
Lee
D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000768:Anesthesia, General / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods*; D001034:Apgar Score; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D004569:Electroencephalography / Q000187:drug effects*; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D016343:Monitoring, Intraoperative / Q000379:methods; D009638:Norepinephrine / Q000097:blood; D010880:Piperidines / Q000494:pharmacology*; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D000077208:Remifentanil; D013874:Thiopental
D000701:Analgesics, Opioid; D010880:Piperidines; D013874:Thiopental; D000077208:Remifentanil; D009638:Norepinephrine; D004837:Epinephrine