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Journal of Anesthesia
Published in: Journal of Anesthesia 2/2016

01-04-2016 | Review Article

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

Authors: Marija S. Kutlesic, Ranko M. Kutlesic, Tatjana Mostic-Ilic

Published in: Journal of Anesthesia | Issue 2/2016

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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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Metadata
Title
Attenuation of cardiovascular stress response to endotracheal intubation by the use of remifentanil in patients undergoing Cesarean delivery
Authors
Marija S. Kutlesic
Ranko M. Kutlesic
Tatjana Mostic-Ilic
Publication date
01-04-2016
Publisher
Springer Japan
Published in
Journal of Anesthesia / Issue 2/2016
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-015-2118-5

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