General anaesthesia with target controlled infusion of propofol for planned caesarean section: maternal and neonatal effects of a remifentanil-based technique

Abstract

The present case series evaluated maternal and neonatal effects of remifentanil, combined with propofol, during general anaesthesia for caesarean delivery. Following written informed consent, ten patients scheduled for semi-elective caesarean section were recruited to this prospective, unblinded trial. All patients with non-reassuring fetal status were excluded. A 0.50-μg/kg bolus of remifentanil was given intravenously, followed by a continuous infusion of 0.20 μg · kg −1min −1. Anaesthesia was induced using propofol target controlled infusion set at a blood concentration of 5 μg/mL, 45 s after the remifentanil bolus. Following tracheal intubation the propofol target was reduced to 2.5 μg/mL and remifentanil maintained at 0.20 μg · kg −1min −1. Mean arterial pressure remained stable throughout anaesthesia. Two patients experienced episodes of hypotension (mean arterial pressure decrease >20%). Although neonatal depression occurred in six babies and assisted mask ventilation was required briefly, recovery was rapid without the need for naloxone or tracheal intubation. Umbilical artery pH was >7.20 in all infants. We conclude that the results of the present case series using a remifentanil/propofol-based technique of general anaesthesia for caesarean section provide a basis to study the safety of this technique in a larger population. Under the conditions of the present trial, this anaesthetic technique seems safe for mother and infant, provided adequate precautions are taken to manage brief, self-limiting infant respiratory depression. At the moment we cannot advise the routine use of this technique, especially since it has not been studied in situations of fetal compromise.