Kutlesic Marija S, Kutlesic Ranko M, Mostic-Ilic Tatjana
Center for Anesthesia, University Clinical Centre Nis, Nis, Serbia.
Clinic of Gynecology and Obstetrics, University Clinical Centre Nis, Zetska bb, 18 000, Nis, Serbia.
J Anesth. 2016 Apr;30(2):274-83. doi: 10.1007/s00540-015-2118-5. Epub 2015 Dec 29.
The induction-delivery time during Cesarean section is traditionally conducted under light anesthesia because of the possibility of anesthesia-induced neonatal respiratory depression. The serious consequences of such an approach could be the increased risk of maternal intraoperative awareness and exaggerated neuroendocrine and cardiovascular stress response to laryngoscopy, endotracheal intubation, and surgical stimuli. Here, we briefly discuss the various pharmacological options for attenuation of stress response to endotracheal intubation during Cesarean delivery and then focus on remifentanil, its pharmacokinetic properties, and its use in anesthesia, both in clinical studies and case reports. Remifentanil intravenous bolus doses of 0.5-1 μg/kg before the induction to anesthesia provide the best compromise between attenuating maternal stress response and minimizing the possibility of neonatal respiratory depression. Although neonatal respiratory depression, if present, usually resolves in a few minutes without the need for prolonged resuscitation measures, health care workers skilled at neonatal resuscitation should be present in the operating room whenever remifentanil is used.
由于麻醉诱导的新生儿呼吸抑制的可能性，剖宫产术中的诱导-分娩时间传统上是在浅麻醉下进行的。这种方法的严重后果可能是产妇术中知晓风险增加，以及对喉镜检查、气管插管和手术刺激的神经内分泌和心血管应激反应过度。在此，我们简要讨论剖宫产分娩期间减轻气管插管应激反应的各种药理学选择，然后重点讨论瑞芬太尼、其药代动力学特性及其在麻醉中的应用，包括临床研究和病例报告。在麻醉诱导前静脉推注0.5-1μg/kg的瑞芬太尼剂量，可在减轻产妇应激反应和将新生儿呼吸抑制的可能性降至最低之间取得最佳平衡。尽管新生儿呼吸抑制（如果出现）通常在几分钟内即可缓解，无需长时间的复苏措施，但无论何时使用瑞芬太尼，手术室都应有熟练掌握新生儿复苏技术的医护人员在场。
