Maternal and foetal effects of remifentanil for general anaesthesia in parturients undergoing caesarean section: a systematic review and meta-analysis.
BACKGROUND
Remifentanil has been suggested for the induction of general anaesthesia for caesarean section. We aimed to define remifentanil effects on maternal stress response as well as neonatal effects.


METHODS
Relevant articles were retrieved by a systematic literature search. Randomized, controlled trials comparing remifentanil use before delivery with placebo were selected. Maternal outcome parameters were blood pressure and heart rate; neonatal effects included the need for mask ventilation and intubation, base excess, pH values, Apgar < 7 at 1 and 5 min. The random effects model was used for meta-analysis; risk ratio or weighted mean difference (WMD) and 95% confidence interval (95% CI) were calculated.


RESULTS
Five articles including 186 patients were identified. Highest and lowest systolic blood pressure were significantly lower in the remifentanil group (WMD: -29.98, -50.90 to -9.07 mmHg, 95% CI; P = 0.005; and WMD: -12.46, -18.21 to -6.71 mmHg, 95% CI; P < 0.0001), the lowest heart rate was significantly lower after remifentanil treatment (WMD: -8.22, -11.67 to -4.78, 95% CI; P < 0.00001). Base excess was significantly higher in infants of remifentanil-treated mothers (WMD: 1.15, -0.27 to 2.03, 95% CI; P = 0.01); pH was also higher in the remifentanil group, but significance was missed (P = 0.07). No differences were observed for Apgar values or the need of airway assist.


CONCLUSIONS
Remifentanil was found to attenuate the maternal circulatory response to intubation and surgery. Higher base excess and pH suggest a beneficial effect on the neonatal acid-base status. A trial with adequate power is warranted that addresses neonatal side-effects of remifentanil.
Department of Anaesthesia, Klinikum Bamberg, Buger Strasse 80, Bamberg, Germany. michael.heesen@sozialstiftung-bamberg.de
M
M
Heesen
S
S
Klöhr
T
T
Hofmann
R
R
Rossaint
S
S
Devroe
S
S
Straube
M
M
Van de Velde
D000328:Adult; D000771:Anesthesia, Intravenous / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001034:Apgar Score; D001794:Blood Pressure / Q000502:physiology; D002585:Cesarean Section; D016001:Confidence Intervals; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D010880:Piperidines / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D000077208:Remifentanil
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil