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

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. 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. 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. 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.