Department of Anesthesiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khubar, Saudi Arabia -
Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura City, Egypt.
Minerva Anestesiol. 2018 Dec;84(12):1343-1351. doi: 10.23736/S0375-9393.18.12312-1. Epub 2018 Mar 7.
Preoperative remifentanil administration blunts hemodynamic responses to tracheal intubation in parturients with severe preeclampsia. We hypothesized that the preoperative administration of low doses of remifentanil or dexmedetomidine would lead to comparable maternal neurohormonal responses and neonatal outcomes in patients with severe preeclampsia.
Parturients diagnosed with severe preeclampsia undergoing caesarean delivery were randomLy allocated to receive remifentanil (0.1 µg/kg/min) or dexmedetomidine (0.4 µg/kg/h) at five min and 20 min before induction, respectively. Changes in maternal mean arterial BP(MAP), clinical recovery, cortisol level, and neonatal outcome, were recorded.
Patients who received remifentanil had higher response in MAP at the induction (94 9.8 vs. 104 4.5; P<0.001) and emergence from anesthesia (94 6.3 vs. 98 5.1; P<0.001), but shorter times to extubation (5.1 1.6 vs. 13.5 2.8 min; P<0.001). Five (27.8%) patients in the remifentanil group received ephedrine versus none in the dexmedetomidine group (P=0.023). The maternal plasma cortisol levels, the neonatal Neurologic and Adaptative Capacity Scores and acid-base satuses were similar in the two groups. Newborns in the remifentanil group presented lower Apgar scores at 1 minute (5.11 0.8 vs. 5.68 0.8; P=0.034) and a higher incidence of respiratory depression (72.2% vs. 36.8% P=0.048).
Compared with dexmedetomidine (0.4 µg/kg/h), the preoperative administration of remifentanil (0.1 µg/kg/min) produced a significantly higher effect on maternal hemodynamic responses to caesarean delivery in patients with severe preeclampsia, however maternal hypotension and neonatal respiratory depression were more common with the use of remifentanil.
瑞芬太尼术前给药可减轻重度子痫前期产妇气管插管时的血流动力学反应。我们假设，在重度子痫前期患者中，术前给予低剂量瑞芬太尼或右美托咪定可导致相似的母体神经激素反应和新生儿结局。
诊断为重度子痫前期并接受剖宫产的产妇被随机分为两组，分别在诱导前 5 分钟和 20 分钟时接受瑞芬太尼（0.1μg/kg/min）或右美托咪定（0.4μg/kg/h）。记录产妇平均动脉压（MAP）的变化、临床恢复情况、皮质醇水平和新生儿结局。
接受瑞芬太尼的患者在诱导时（94 9.8 比 104 4.5；P<0.001）和麻醉苏醒时（94 6.3 比 98 5.1；P<0.001）的 MAP 反应更高，但拔管时间更短（5.1 1.6 比 13.5 2.8 分钟；P<0.001）。瑞芬太尼组中有 5 名（27.8%）患者接受了麻黄碱，而右美托咪定组中没有患者接受麻黄碱（P=0.023）。两组产妇血浆皮质醇水平、新生儿神经和适应能力评分以及酸碱状态相似。瑞芬太尼组新生儿在 1 分钟时的 Apgar 评分较低（5.11 0.8 比 5.68 0.8；P=0.034），呼吸抑制发生率较高（72.2%比 36.8%；P=0.048）。
与右美托咪定（0.4μg/kg/h）相比，术前给予瑞芬太尼（0.1μg/kg/min）可显著增加重度子痫前期患者剖宫产时的母体血流动力学反应，但瑞芬太尼的使用更常见母体低血压和新生儿呼吸抑制。
