Key result
Remifentanil lowers SBP ~5 mmHg vs fentanyl, avoiding severe hemodynamic spikes during intubation in preeclampsia.
Why the study?
Intravenous opioids are used to control hemodynamic changes due to endotracheal intubation, but their use in preeclamptic parturients for cesarean section is limited due to concerns about neonatal respiratory depression.
Does remifentanil compared to fentanyl improve hemodynamic stability during endotracheal intubation in preeclamptic women undergoing cesarean delivery?
Population
Preeclamptic pregnant women candidate for cesarean section under general anesthesia
Comparison
Remifentanil infusion vs fentanyl injection before induction
Design
Single-blind randomized clinical trial
Follow-up
Before and after intubation
Authors
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Remifentanil may better blunt intubation hemodynamics in preeclamptic cesarean deliveries without Apgar impact; leaves open need for larger confirmatory trials.
RCT (n=38)
Single-blind
Block randomization
No
Does remifentanil compared to fentanyl improve hemodynamic stability during endotracheal intubation in preeclamptic women undergoing cesarean delivery?
Absolute Event Rate: 148.35% vs 153.11%
Remifentanil can be used in preeclamptic parturients undergoing cesarean delivery under general anesthesia to prevent severe increases in blood pressure and heart rate during tracheal intubation without adverse effects on the newborn.
Pournajafian et al. (2012) conducted an RCT in Preeclampsia (n=38). Remifentanil vs. Fentanyl 50 µg bolus was evaluated on Systolic blood pressure (mmHg) after endotracheal intubation. Remifentanil infusion before endotracheal intubation in preeclamptic women undergoing cesarean delivery significantly decreased systolic blood pressure from baseline (P=0.018), avoiding the severe hemodynamic increases seen with fentanyl.
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