Effect of Remifentanil on Blood Pressure and Pulse Rate of Mothers and Apgar Score of Neonates during General Anesthesia in Elective Cesarean Section

Analgesia and reduction of hemodynamic changes during laryngoscopy and intubation are important aims of general anesthesia, this aim usually obtained by administration of opioids. Since opioid drugs may cause respiratory depression in the neonates, they are usually omitted at induction of anesthesia for cesarean. But in conditions such as maternal heart disease, increase in heart rate and blood pressure may be detrimental, and use of an opioid can be justified. Short acting opioids for example remifentanil can have less side effects in the neonates. The aim of this study was to evaluate the effects of remifentanil on maternal hemodynamic changes and neonatal Apgar scores during cesarean section. In this double blinded randomized clinical trial, 100 patients aged 18-30 years who underwent elective cesarean section, divided randomly into two equal groups (N=50). Remifentanil was infused at a dose of 0.2µg/kg/min in study group and normal saline was infused in control group. Maternal blood pressure and heart rate were measured before induction and then every 1 minute. Apgar scores were measured 1 and 5 min after birth in both groups and then compared. Mean systolic arterial pressure, 1 and 5 minutes after the intubation was 118.28±15.16, 125.30±15.24 and 118.04±21.13 mmHg in case group and it was 124.78±17.57, 147.20±28.20 and 133.80±23.76 mmHg in control group that the difference was statistically significant (p<0.05). The mean of first minute Apgar Score was 8.84±0.42 in remifentanil group and 8.56±0.57 in control group. The fifth minute Apgar score in both groups was 10. According to the results of this study, infusion of remifentanil effectively attenuated the hemodynamic changes after induction and tracheal intubation. Since, remifentanil crosses the placenta and may cause mild respiratory depression in neonates so it should be used for clear maternal indications when adequate facilities for resuscitation of neonates are available.