Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Department of Pediatrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Drug Des Devel Ther. 2023 May 8;17:1395-1403. doi: 10.2147/DDDT.S407602. eCollection 2023.
Remifentanil, in combination with etomidate and sevoflurane, is commonly used in clinics for general anesthesia induction in cesarean section (CS). This study aimed to evaluate the correlation between the induction to delivery (I-D) time and neonatal plasma drug concentration and anesthesia, as well as its effects on neonates.
Fifty-two parturients in whom general anesthesia was induced for CS were divided into group A (I-D<8 min) and group B (I-D≥8 min). Maternal arterial (MA), umbilical venous (UV), and umbilical arterial (UA) blood samples were collected at delivery to analyze the remifentanil and etomidate concentrations using liquid chromatography-tandem mass spectrometry.
There were no statistically significant differences between the two groups in terms of plasma concentrations of remifentanil in the MA, UA, and UV blood (P > 0.05). The plasma concentration of etomidate in MA and UV was higher in group A than that in group B (P<0.05), whereas the UA/UV ratio of etomidate was higher in group B than that in group A (P<0.05). The Spearman rank correlation test showed no correlation between the I-D time and plasma remifentanil concentration in the MA, UA, and UV plasma (P>0.05). The concentrations of etomidate in the MA and UV were negatively correlated with the I-D time (P < 0.05).
Prolonged I-D time did not significantly influence the maternal or neonatal plasma concentration of remifentanil. It is safe to administer remifentanil target-controlled infusion in combination with etomidate and sevoflurane for general anesthesia induction during CS.
瑞芬太尼复合依托咪酯和七氟醚常用于剖宫产术（CS）的全麻诱导。本研究旨在评估诱导至分娩（I-D）时间与新生儿血浆药物浓度和麻醉的相关性及其对新生儿的影响。
将 52 例行 CS 全麻诱导的产妇分为 A 组（I-D<8 分钟）和 B 组（I-D≥8 分钟）。分娩时采集产妇动脉（MA）、脐静脉（UV）和脐动脉（UA）血样，采用液相色谱-串联质谱法分析瑞芬太尼和依托咪酯的浓度。
两组 MA、UA 和 UV 血中瑞芬太尼的血浆浓度无统计学差异（P>0.05）。A 组 MA 和 UV 中依托咪酯的血浆浓度高于 B 组（P<0.05），而 B 组 UA/UV 比值高于 A 组（P<0.05）。Spearman 秩相关检验显示，I-D 时间与 MA、UA 和 UV 血浆中瑞芬太尼的血浆浓度无相关性（P>0.05）。MA 和 UV 中的依托咪酯浓度与 I-D 时间呈负相关（P<0.05）。
延长 I-D 时间不会显著影响产妇或新生儿瑞芬太尼的血浆浓度。在 CS 中使用瑞芬太尼靶控输注复合依托咪酯和七氟醚进行全麻诱导是安全的。
