Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

Abstract

BackgroundIntravenous opioids are administered to prevent and control hemodynamic changes due to endotracheal intubation. Except for special cases such as preeclampsia, these drugs are not recommended for parturants candidate for cesarean section because of the respiratory depression caused in the newborn.ObjectivesAccording to rapid metabolism of remifentanil, the current study aimed to compare hemodynamic changes in preeclamptic parturants who received remifentanil and fentanyl for cesarean section under general anesthesia.Patients and MethodsThis single blind randomized clinical trial was performed on preeclamptic pregnant women candidate for cesarean section under general anesthesia. They were divided into two groups. In the first group 0.05 μg/kg/min remifentanil was infused for 3 minutes before induction of anesthesia and in the second group 1ml (50 μg) fentanyl was injected before induction. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after intubation and also Apgar index were measured and compared between the two groups.ResultsAll hemodynamic variables increased after intubation in the fentanyl group (pSBP = 0.146, pDBP = 0.019, pHR < 0.001). Additionally, decrease in SBP (P = 0.018) and DBP (P = 0.955) and mild increase in HR (P = 0.069) after intubation in the remifentanil group was observed. No significant difference was found between Apgar indexes of the two groups (P = 0.771).ConclusionsIt can be postulated that remifentanil can be used in partituents candidate for cesarean delivery under general anesthesia to prevent severe increase in blood pressure and heart rate during tracheal intubation without adverse effects on newborn.

Simulation Study Assessing Healthcare Provider’s Knowledge of Pre-Eclampsia and Eclampsia in a Tertiary Referral Center

“…Recommended drugs in addition to an induction agent and a depolarizing muscle relaxant to reduce the intubating response include esmolol 1.5 mg/kg, esmolol 1 mg/kg, lidocaine 1.5 mg/kg, or an opioid such as remifentanil. 18,20,21 Whichever drug the anesthesiologist uses, it is important that they are familiar with the drug in terms of onset time and desired effect and are not using it for the first time in an event when precise timing in relation to laryngoscopy is critical. Extubation is also a critical time when drug modification(s) need to be considered to avoid an acute rise in blood pressure.…”

Comparison of hemodynamic response to tracheal intubation and postoperative pain in patients undergoing closed reduction of nasal bone fracture under general anesthesia: a randomized controlled trial comparing fentanyl and oxycodone

“…Endotracheal intubation during general anesthesia excites the sympathetic nervous system, leading to increased blood pressure and heart rate [1, 2]. Presently, to prevent the occurrence of these hemodynamic changes during intubation, the patient can be administered opioids, topical and intravenous (IV) lidocaine or alpha and beta blockers [3].…”

Controle perioperatório de gestante obesa mórbida submetida a parto cesariano sob anestesia geral – relato de caso

“…17 Por isso, pode não ter a desvantagem da depressão respiratória neonatal associada ao fentanil e ao alfentanil. 18,19 A diminuição da capacidade residual funcional e o aumento na demanda de O 2 na gravidez resultam em mais rápido início da dessaturação de oxi-hemoglobina durante apneia em comparação com mulheres não gestantes. Na gestante obesa mórbida a instalação da dessaturação pode ser, ainda, mais rápida.…”