REVIEW   Free

Minerva Anestesiologica 2017 August;83(8):858-66

DOI: 10.23736/S0375-9393.17.11470-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Effect of remifentanil for general anesthesia on parturients and newborns undergoing cesarean section: a meta-analysis

Yunhui ZHANG, Hongmei LU, Zheng FU, Huijun ZHANG, Ye LI, Wei LI, Jingui GAO ✉

Department of Anesthesia, the Second Hospital of Hebei Medical University, Shijiazhuang, China

INTRODUCTION: The results presented by studies investigating the effect of remifentanil on both parturients and newborns during cesarean section differed significantly. Therefore, we performed a meta-analysis to estimate the effect of remifentanil on these patients.
EVIDENCE ACQUISITION: Potentially eligible studies published before 15 March 2016 were searched through four databases including PubMed, SCOPUS, ISI web of knowledge and EBSCO. Weighted mean difference (WMD) or odds ratios (ORs) and the corresponding 95% confidence interval (CI) were applied to estimate the strength of relationship.
EVIDENCE SYNTHESIS: A total number of seven randomized-controlled trials were included in this meta-analysis. The results showed that Apgar values at 1 min and 5 min were significantly lower in the infants of remifentanil-treated mothers, with the WMD and corresponding 95% CI of -0.835 (-1.515, -0.154) and -0.296 (-0.570, -0.021), respectively. The pH value of umbilical artery was significantly higher in the remifentanil group (WMD: 0.014, 95% CI: 0.002, 0.025). The highest and lowest systolic blood pressures were significantly lower in remifentanil-treated mothers, with the WMD and corresponding 95% CI of -18.913 (-34.468, -3.359) and -12.982 (-21.479, -4.485), respectively.
CONCLUSIONS: Remifentanil shows potential value of maternal circulation response during general anesthesia, which reduces maternal blood pressure in response to intubation and surgery. However, whether it is beneficial for the neonate is still controversial. More randomized-controlled trials with larger sample size are required to assess the adverse effects of remifentanil.

KEY WORDS: Remifentanil - Anesthesia, general - Cesarean section - Meta-analysis