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Remifentanil Bolus at Induction of General Anesthesia did not Produce Further Reduction in Bispectral Index for Cesarean Section: A Randomized, Double-blind, Controlled Trial
Abstract Number: O1-6
Abstract Type: Original Research
Background: To prevent possible neonatal depression, opioids and sedatives are generally avoided in inducing general anesthesia for cesarean delivery, which, therefore, is well characterized as a high risk for accidental awareness during general anesthesia, especially before delivery. In this randomized, double-blinded, prospective trial, we investigated whether single bolus injection of remifentanil, a short-acting opioid, during induction of general anesthesia for cesarean delivery, can reduce the bispectral index (BIS).
Methods: Sixty nulliparous singleton women undergoing elective cesarean delivery with general anesthesia were randomly assigned to receive remifentanil 1 μg/kg (R 1), 0.5 μg/kg (R 0.5), or saline (control), in addition to standard rapid sequence induction with propofol 2 mg/kg and succinylcholine 1.5 mg/kg. The vital signs and BIS were recorded continuously during cesarean procedure. The potential effect of remifentanil on newborn was evaluated by Apgar's scores and umbilical blood PH analysis. 24 hours after cesarean delivery, all the patients were reviewed for detecting any awareness during the cesarean delivery.
Results: There was no difference in BIS between the three groups, as showed in figure 1a, in which the shaded areas showed the 95% confidence intervals. The areas between the two sets of dotted lines showed the 95% confidence interval for intubation and newborn delivery, respectively. None of the patients reported any intraoperative awareness. There was no difference in neonatal Apgar's score or umbilical PH either. However, addition of remifentanil did prevent intubation-induced hypertension, as showed in figure 1b.
Conclusions: Remifentanil, at the dose as high as 1 μg/kg remifentanil was safe for the women and the fetus undergoing cesarean delivery under general anesthesia. However, it failed to reduce the BIS before the newborn was delivered.