Kan R E, Hughes S C, Rosen M A, Kessin C, Preston P G, Lobo E P
Department of Anesthesia, University of California, San Francisco, USA.
Anesthesiology. 1998 Jun;88(6):1467-74. doi: 10.1097/00000542-199806000-00008.
Remifentanil has not been studied in obstetric patients. This study evaluates the placental transfer of remifentanil and the neonatal effects when administered as an intravenous infusion.
Nineteen parturients underwent nonemergent cesarean section with epidural anesthesia and received 0.1 microg kg(-1) x min(-1) remifentanil intravenously, which was continued until skin closure. Maternal arterial (MA), umbilical arterial (UA), and umbilical venous (UV) blood samples were obtained at delivery for analysis of drug concentrations of remifentanil, its metabolite, and blood gases. Maternal vital signs were monitored continuously, and pain and sedation levels were assessed intermittently. Apgar scores were obtained at 1, 5, 10, and 20 min, and Neonatal and Adaptive Capacity Scores were noted 30 and 60 min after delivery. Parturients and newborns were observed for at least 24 h after surgery for side effects.
The means and SDs of UV:MA and UA:UV ratios for remifentanil were 0.88+/-0.78 and 0.29+/-0.07, respectively. Mean clearance was 93 ml x min(-1) kg(-1). The mean UV:MA and UA:MV ratios for remifentanil acid were 0.56+/-0.29 and 1.23+/-0.89, respectively. The mean MA (remifentanil acid):MA (remifentanil) ratio was 2.92+/-3.65. There were no adverse effects on the neonates, but there was a sedative effect and respiratory depressant effect on the mothers.
Remifentanil crosses the placenta but appears to be rapidly metabolized, redistributed, or both. Maternal sedation and respiratory changes occur, but without adverse neonatal or maternal effects.
尚未对产科患者使用瑞芬太尼进行研究。本研究评估瑞芬太尼静脉输注时的胎盘转运情况及对新生儿的影响。
19例产妇在硬膜外麻醉下行非急诊剖宫产术，静脉输注0.1微克·千克⁻¹·分钟⁻¹瑞芬太尼，持续至皮肤缝合。分娩时采集产妇动脉血（MA）、脐动脉血（UA）和脐静脉血（UV）样本，分析瑞芬太尼及其代谢产物的药物浓度和血气。持续监测产妇生命体征，间断评估疼痛和镇静程度。分别在1、5、10和20分钟时记录阿氏评分，并在分娩后30和60分钟记录新生儿适应性能力评分。术后观察产妇和新生儿至少24小时，记录副作用情况。
瑞芬太尼的UV:MA和UA:UV比值的均值及标准差分别为0.88±0.78和0.29±0.07。平均清除率为93毫升·分钟⁻¹·千克⁻¹。瑞芬太尼酸的平均UV:MA和UA:MV比值分别为0.56±0.29和1.23±0.89。MA（瑞芬太尼酸）:MA（瑞芬太尼）的平均比值为2.92±3.65。对新生儿无不良影响，但对母亲有镇静和呼吸抑制作用。
瑞芬太尼可通过胎盘，但似乎迅速代谢、再分布或两者兼有。产妇出现镇静和呼吸变化，但对新生儿或产妇无不良影响。
