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Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery

Journal of Anesthesia volume 30, pages 274–283 (2016)Cite this article

Abstract

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.

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Authors and Affiliations

  1. Center for Anesthesia, University Clinical Centre Nis, Nis, Serbia

    Marija S. Kutlesic

  2. Clinic of Gynecology and Obstetrics, University Clinical Centre Nis, Zetska bb, 18 000, Nis, Serbia

    Marija S. Kutlesic & Ranko M. Kutlesic

  3. Faculty of Medicine, University of Nis, Nis, Serbia

    Ranko M. Kutlesic

  4. Department of Anaesthesiology, Institute of Gynecology and Obstetrics, Belgrade, Serbia

    Tatjana Mostic-Ilic

  5. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Tatjana Mostic-Ilic

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  1. Marija S. Kutlesic
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  2. Ranko M. Kutlesic
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  3. Tatjana Mostic-Ilic
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Correspondence to Marija S. Kutlesic.

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Kutlesic, M.S., Kutlesic, R.M. & Mostic-Ilic, T. Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery. J Anesth 30, 274–283 (2016). https://doi.org/10.1007/s00540-015-2118-5

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  • DOI: https://doi.org/10.1007/s00540-015-2118-5

Keywords

  • Anesthesia
  • Obstetrical
  • Intubation
  • Endotracheal
  • Remifentanil