| Background At present,the intrathecal anesthesia is the most common anesthesia methods in cesarean delivery,because the effection for parturient and neonates is very small.But for some patients with intrathecal anesthesia contraindications,general anesthesia is a suitable choice.Remifentanil is a kind of short acting narcotic analgesics with strong analgesic effect,short working time,rapid metabolism and no accumulation,but its inhibition on circulation and respiration are dose-dependent.Remifentanil is easily to permeate the placental barrier,and cause the inhibition of respiration and circulation of neonates.In this study,using remifentanil to implement obstetric induction of general anesthesia,we detect the umbilical artery and vein blood concentration of remifentanil in parturient and neonates,observe its effects on neonatal respiratory and Apgar score,explore its clinical application prospect.Objective This research was designed to induce general anesthesia induction for cesarean delivery in parturient with different doses of remifentanil,evaluate the hemodynamics of parturient and the newborn respiration,apgar score and blood gas indexes,determination the remifentanil concentration of cord blood and parturient,discuss the safe induction dose of remifentanil in general anesthesia cesarean delivery.Methods90 cases of parturient,were full-term pregnant women and primipara,aged from 20 to45 years old,weight between 60~84kg,ASA I and II.Surgical incision is type I or II incision.Heart,lung,liver and kidney have no obvious abnormalities.There were no gestational disease,with intrathecal anesthesia contraindications(such as coagulation dysfunction,severe lumbar lesions,and so on).There were not hemodynamic disturbancewith and fetal distress in uterus.Fetal heart was normal before operation.The patients were randomly divided into 3 groups according to different doses of remifentanil(n=30each):(group A)1.0μg/kg,(group B)1.5μg/kg,(group C)2.0μg/kg.We chose Propofol 1.5mg/kg+Rocuronium 0.6mg/kg with Remifentanil 1.0μg/kg,1.5μg/kg and 2.0μg/kg for the induction of general anesthesia.After the delivery of fetus,three groups used target controlled infusion of propofol,remifentanil and intermittent intravenous injection of rocuronium to maintain anesthesia.Tidal volume is 8ml/kg,oxygen flow 2.0L/min,inhaled oxygen is 80%,breath is 1:2,respiratory rate was 12 beats per minute.Record the general data of patients with age,weight,height,fetal childbirth time,preoperative fetal heart rate,gestational age etc;before induction(T1),immediate skin incision(T2),immediate after intubation(T3)record HR,SBP,DBP;immediate after intubation(T3),immediate after delivery of fetus(T4),determination of blood concentration of remifentanil from maternal arterial blood 5ml;collect umbilical vein and artery blood5 ml from placenta side umbilical cord,determination of blood concentration of remifentanil and umbilical artery blood gas analysis : p H value,oxygen pressure and carbon dioxide;after delivery of fetus,record 1min,5mins,10 mins the neonatal Apgar score,observe and count the newborn respiratory depression,neonatal mask oxygen inhalation,naloxone treatment,endotracheal intubation.Results1.General situation: there were no significant differences in the age,weight,height,gestational age,fetal heart rate,the delivery time in the groups(P>0.05).2.Hemodynamic index2.1 SBP: A,B,C three groups of patients before anesthesia,comparison among groups,have no significant difference(P>0.05);A group,compared T2,T3 and T1,have significant difference(P<0.05);comparison among group T2,T3,have statistical significance the difference(P<0.05);B group and C group,compared T2,T3 and T1,and the compared B to C,have significant difference(P>0.05).2.2 DBP: A,B,C three groups of patients before anesthesia,comparison among groups,have no significant difference(P>0.05);A group,compared T2,T3 and T1,have significant difference(P<0.05);comparison among group T2,T3,have statistical significance the difference(P<0.05);B group and C group,compared T2,T3 and T1,and the compared B to C,have significant difference(P>0.05).2.3 HR:A,B,C three groups of patients before anesthesia,comparison among groups,have no significant difference(P>0.05);A group,compared T2,T3 with T1,have significant difference(P<0.05);comparison among group T2,T3,have statistical significance the difference(P<0.05);B group and C group,compared T2,T3 with T1,and the compared B to C,have significant difference(P>0.05).3.Umbilical artery blood gas indicators: A,B,C three groups of patients in the p H value,umbilical arterial blood oxygen and carbon dioxide partial pressure,comparison among groups,have significant difference(P>0.05).4.Remifentanil concentration in cord blood:4.1The concentration of remifentanil in umbilical vein(UV): A,B,C three groups,the concentration of remifentanil are 0.63±0.14ng/ml,0.99±0.24ng/ml,1.39±0.29ng/ml;4.2 The concentration of remifentanil in umbilical artery(UA): A,B,C three groups,the concentration of remifentanil are 0.32±0.09ng/ml、0.60±0.36ng/ml、0.89±0.41ng/ml.4.3 UA/UV:A,B,C three groups are 0.62±0.06、0.65±0.21、0.64±0.33.5.The concentration of remifentanil in maternal radial artery: A,B,C three groups at T3,T4,the blood drug concentration are 1.41±0.51ng/ml,2.14±0.88ng/ml,2.97±1.09ng/ml and 0.89±0.38ng/ml,1.38±0.20ng/ml,1.89±0.40ng/ml.6.The neonatal apgar score and treatment,apgar score: A,B,C three groups,Comparison among groups,have no significant difference in 1min,5min,10min(P>0.05);in group A newborn with no breathing,in group B there was 1 case with mild breathing inhibition,by beat foot stimulation,after pressurized oxygen mask,respiration returned to normal,in group C,there were 2 cases with mild breathing inhibition,by beat foot stimulation,after pressurized oxygen mask,respiration returned to normal,no respiratory depression occurred at 5 mins and 10 mins after birth.Conclusion According to the comparison of different doses of remifentanil in general anesthesia cesarean delivery,there are no obvious effect on Hemodynamic of Parturient,Neonatal respiratory function,apgar score and Blood gas index of neonatal umbilical artery by using of 1.5μg/kg and 2μg/kg.They are both suitable induction doses in general anesthesia cesarean delivery. |
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