Ngan Kee Warwick D, Khaw Kim S, Ma Kwok C, Wong April S Y, Lee Bee B, Ng Floria F
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Anesthesiology. 2006 Jan;104(1):14-20. doi: 10.1097/00000542-200601000-00004.
Use of remifentanil during general anesthesia for cesarean delivery has been described, but its maternal and neonatal effects have not been investigated by a controlled study.
In a randomized, double-blind, controlled study, patients undergoing elective cesarean delivery received an intravenous bolus of 1 microg/kg remifentanil (n = 20) or saline (n = 20) immediately before induction of general anesthesia. The authors compared maternal hemodynamic changes and neonatal condition and measured plasma concentrations of remifentanil.
The maximum increase in systolic arterial pressure from baseline after induction was smaller in the remifentanil group (median, 9 [range, -17 to 31] mmHg) compared with the control group (42 [6-73] mmHg, median difference, 33 mmHg; 95% confidence interval of difference, 23-45 mmHg; P < 0.0001). Maximum recorded values were smaller in the remifentanil group compared with the control group for systolic and mean arterial pressure and maternal heart rate. Apgar scores and time to sustained respiration were similar between groups. Two neonates in the remifentanil group were considered clinically depressed at birth and were given a single dose of naloxone. Remifentanil crossed the placenta with an umbilical venous/maternal arterial concentration ratio of 0.73 (SD, 0.17) and an umbilical arterial/umbilical venous concentration ratio of 0.60 (0.23).
A single bolus of 1 microg/kg remifentanil effectively attenuated hemodynamic changes after induction and tracheal intubation. However, remifentanil crosses the placenta and may cause mild neonatal depression and thus should be used for clear maternal indications when adequate facilities for neonatal resuscitation are available.
已有剖宫产全身麻醉期间使用瑞芬太尼的相关描述，但尚未通过对照研究对其母婴效应进行调查。
在一项随机、双盲、对照研究中，择期剖宫产患者在全身麻醉诱导前即刻静脉推注1微克/千克瑞芬太尼（n = 20）或生理盐水（n = 20）。作者比较了产妇的血流动力学变化和新生儿状况，并测定了瑞芬太尼的血浆浓度。
与对照组（42 [6 - 73] mmHg，中位数差异为33 mmHg；差异的95%置信区间为23 - 45 mmHg；P < 0.0001）相比，瑞芬太尼组诱导后收缩压较基线的最大升高幅度较小（中位数为9 [范围，-17至31] mmHg）。瑞芬太尼组收缩压、平均动脉压和产妇心率的最大记录值均低于对照组。两组间阿氏评分和持续呼吸时间相似。瑞芬太尼组有两名新生儿出生时被判定为临床抑郁，并给予了单剂量纳洛酮。瑞芬太尼可通过胎盘，脐静脉/母体动脉浓度比为0.73（标准差为0.17），脐动脉/脐静脉浓度比为0.60（0.23）。
单次静脉推注1微克/千克瑞芬太尼可有效减轻诱导和气管插管后的血流动力学变化。然而，瑞芬太尼可通过胎盘，可能导致轻度新生儿抑郁，因此，当有足够的新生儿复苏设备时，应在有明确产妇指征时使用。
