Dexmedetomidine vs. Remifentanil for Pre-eclampsia During Caesarean Delivery
Status:
Completed
Trial end date:
2017-01-01
Target enrollment:
Participant gender:
Summary
Preeclampsia is a pregnancy-specific, multisystem disorder that complicates approximately 5 %
of pregnancies.
Tracheal intubation in the women with severe pre-eclampsia is usually associated with
exaggerated transient increases in blood pressure, heart rate and maternal plasma
catecholamine concentrations. These changes may lead to maternal cerebral oedema,
haemorrhage, left ventricular failure, pulmonary oedema or mortality, and reduce uterine
blood flow which may adversely affect the neonatal wellbeing. Therefore, the attenuation of
the haemodynamic responses to tracheal intubation in this unique group of patients is
demanding for the best of both mother and foetus.
The use of single remifentanil boluses of 0.5 to 1 µg/kg reduces effectively the haemodynamic
and catecholamine responses to laryngoscopy and tracheal intubation in severe pre-eclamptics
during Cesarean delivery under general anesthesia. Unfortunately, the use of 1 µg/kg doses
are associated with more maternal hypotension and neonatal respiratory depression requiring
resuscitation. Moreover, the use of preinduction remifentanil bolus of 0.5 µg/kg followed by
a continuous infusion at 0.15-0.2 µg/kg/min is associated with significant attenuation of the
maternal stress response to tracheal intubation with variable degree of neonatal depression
in non-pre-eclamptic women. Whereas, the use of infusion rates of 0.1 µg/kg/min or less is
less likely to produce neonatal depression.
In our previous study, we demonstrated that the preoperative administration of
dexmedetomidine 0.4 and 0.6 µg/kg/h, a specific alpha 2-adrenoceptor agonist, blunts the
maternal haemodynamic and hormonal responses to Caesarean delivery under sevoflurane
anaesthesia without adverse neonatal effects. However the use of 0.6 µg/kg/h doses is
associated with higher postoperative sedation scores.