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.

Magnesium, one of the essential elements in the human body, has numerous favorable effects that offer a variety of possibilities for its use in obstetric anesthesia and intensive care. Administered as a single intravenous bolus dose or a bolus followed by continuous infusion during surgery, magnesium attenuates stress response to endotracheal intubation, and reduces intraoperative anesthetic and postoperative analgesic requirements, while at the same time preserving favorable hemodynamics. Applied as part of an intrathecal or epidural anesthetic mixture, magnesium prolongs the duration of anesthesia and diminishes total postoperative analgesic consumption with no adverse maternal or neonatal effects. In obstetric intensive care, magnesium represents a first-choice medication in the treatment and prevention of eclamptic seizures. If used in recommended doses with close monitoring, magnesium is a safe and effective medication.

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Introduction. Eclampsia, serious complication of preeclampsia, can further be complicated by intracranial haemorrhage. Cesarean section under general anesthesia represents an additional risk factor. Case report. We present a case of 22 years old primipara in the 38th gestational week who after a sudden occurrence of a headache, within one hour developed eclampsia. Emergent Caesarean section was undertaken; she was intubated after several attempts. Severe tongue and hypopharyngeal edema and haemathoma made the extubation impossible; she remained intubated, sedated, mechanically ventilated, on anti-oedematous, anticonvulsive, antihypertensive therapy. On the third postoperative day, tracheostomy was performed. On the sixth day, she complained of a headache and visual disturbances. Neurological examination revealed left-sided hemiparesis. Multislice computed tomography showed intracranial hemorrhage. It was not until the closure of tracheostoma (eleventh day) that her blood pressure normalized and the headache ceased. Four days later she was dismissed from the hospital with improved clinical state. Conclusion. In order to avoid sudden and unexpected, but serious complications of preeclampsia/eclampsia, we emphasize the need of searching for more subtle signs of the disease, of prompt radiologic diagnosis and aggressive blood pressure control, with a prepared strategy for difficult airway management.