The Effect of Premedication by Remifentanil and Magnesium Sulfate in Hemodynamic Responses to Tracheal Intubation in Cesarean Section Delivery: 1 A Randomized Double-Blinded Controlled Study
Background: The preventing effects of remifentanil and magnesium sulfate on hemodynamic responses to tracheal intubation were evaluated in a double-blinded controlled trial on pregnant women undergoing cesarean section delivery.
Methods: A total of 54 American Society of Anesthesiologists Class I-II women candidate for cesarean section delivery were randomly assigned to one of three groups (n = 18) to receive one of the following premedication: Intravenous (IV) remifentanil 0.75 µg/kg, IV magnesium sulfate 30 mg/kg, or IV normal saline 10 cc as placebo. All hemodynamic profiles were recorded immediately before and after intubation, and 2, 3, 5 minutes after tracheal intubation.
Results: Heart rate and systolic and diastolic blood pressures were significantly lower in the remifentanil group than in other groups both before and immediately after intubation. The trend of the changes in homodynamic responses within 5 minutes following intubation in the magnesium sulfate and placebo group was similar, but this trend in the remifentanil group was significant difference. In the same time, 1st and 5th minute Apgar scores were slightly lower in the remifentanil group than others. The measured parameters of umbilical cord blood pH and PO had no significant differences between the groups.
Conclusions: Remifentanil can attenuate hemodynamic response to tracheal intubation more effectively than magnesium sulfate, and thus it can be considered safe for a pregnant candidate for cesarean section.
2. Park SJ, Shim YH, Yoo JH, Nam SH, Lee JW. Low-dose remifentanil to modify hemodynamic responses to tracheal intubation: comparison in normotensive and untreated/treated hypertensive Korean patients. Korean J Anesthesiol. 2012; 62(2): 135-41.
3. Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs. 2005; 65(13): 1793-823.
4. Barclay K, Kluger MT. Effect of bolus dose of remifentanil on haemodynamic response to tracheal intubation. Anaesth Intensive Care. 2000; 28(4): 403-7.
5. Cafiero T, Mastronardi P, Burrelli R, Santoro R. The effects of remifentanil on hemodynamic response to intubation. A comparative study with fentanyl. Minerva Anestesiol. 2000; 66(11): 793-7. [In Italian].
6. Hoke JF, Cunningham F, James MK, Muir KT, Hoffman WE. Comparative pharmacokinetics and pharmacodynamics of remifentanil, its principle metabolite (GR90291) and alfentanil in dogs. J Pharmacol Exp Ther. 1997; 281(1): 226-32.
7. Patel SS, Spencer CM. Remifentanil. Drugs. 1996; 52(3):417-27.
8. Puri GD, Marudhachalam KS, Chari P, Suri RK. The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease.Anesth Analg. 1998; 87(4): 808-11.
9. James MF, Beer RE, Esser JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg. 1989; 68(6): 772-6.
10. Allen RW, James MF, Uys PC. Attenuation of the pressor response to tracheal intubation in hypertensive proteinuric pregnant patients by lignocaine, alfentanil and magnesium sulphate. Br J Anaesth. 1991; 66(2): 216-23.
11. O'Hare R, McAtamney D, Mirakhur RK, Hughes D,Carabine U. Bolus dose remifentanil for control of
haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. Br J Anaesth.1999; 82(2): 283-5.
12. Hall AP, Thompson J, Leslie N, Kumar N, Fox AJ,Rowbotham DJ. Comparison of different doses of
remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation. Br J Anaesth.
2000; 84(1): 100-2.
13. Maguire AM, Kumar N, Parker JL, Rowbotham DJ,Thompson JP. Comparison of effects of remifentanil and alfentanil on cardiovascular response to tracheal intubation in hypertensive patients. Br J Anaesth. 2001;86(1): 90-3.
14. Thompson JP, Hall AP, Russell J, Cagney B, Rowbotham DJ. Effect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth. 1998; 80(4): 467-9.
15. Hogue CW, Bowdle TA, O'Leary C, Duncalf D, Miguel R, Pitts M, et al. A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery. Anesth Analg. 1996; 83(2):279-85.
16. Gwak MS, Choi SJ, Yoon JS, Lee JY, Yang M, Kim GS,et al. Hemodynamic responses to rapid sequence
endotracheal intubation using propofol and rocuronium at three different doses of remifentanil infusion. Korean Journal of Anesthesiology. 2006; 50(4): 385-9.
17. Cha JW, Kwak SH, Kim SJ, Choi JI, Kim CM, Jeong ST,et al. Optimal dose of remifentanil to blunt hemodynamic response to laryngoscopy and endotracheal intubationduring induction of anesthesia with propofol. KoreanJournal of Anesthesiology. 2006; 51(3): 292-6.
18. Hill D. The use of remifentanil in obstetrics. Anesthesiol Clin. 2008; 26(1): 169-82, viii.
19. Miyawaki Y, Yumiba T, Asaga T, Taie S, Shirakami G. Remifentanil is useful for cardiovascular stability duringcesarean delivery in a parturient with Marfan's syndrome.Masui. 2010; 59(10): 1305-7. [In Japanese].
20. Ngan Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB,Ng FF. Maternal and neonatal effects of remifentanil at induction of general anesthesia for cesarean delivery: a randomized, double-blind, controlled trial.Anesthesiology. 2006; 104(1): 14-20.
21. Palacio FJ, Ortiz-Gomez JR, Fornet I, Lopez MA,Morillas P. Remifentanil bolus for cesarean section in
high-risk patients: study of 12 cases. Rev Esp AnestesiolReanim. 2008; 55(2): 86-9. [In Spanish].
22. Douglas WW, Rubin RP. The mechanism of catecholamine release from the adrenal medulla and the
role of calcium in stimulus—secretion coupling. J Physiol. 1963; 167(2): 288-310.
23. Kimura T, Yasue H, Sakaino N, Rokutanda M, Jougasaki M, Araki H. Effects of magnesium on the tone of isolated human coronary arteries. Comparison with diltiazem and nitroglycerin. Circulation. 1989; 79(5): 1118-24.
24. Miyagi H, Yasue H, Okumura K, Ogawa H, Goto K,Oshima S. Effect of magnesium on anginal attack
induced by hyperventilation in patients with variant angina. Circulation. 1989; 79(3): 597-602.
25. Vigorito C, Giordano A, Ferraro P, Acanfora D, de Caprio L, Naddeo C, et al. Hemodynamic effects of magnesium sulfate on the normal human heart. Am JCardiol. 1991; 67(16): 1435-7.
|Issue||Vol 2 No 3-4 (2015)|
|Cesarean section Hemodynamic response Intubation Intratracheal Magnesium sulphate Pregnant women Remifentanil|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|