Remifentanil vs dexmedetomidine for severely preeclamptic parturients scheduled for cesarean section under general anesthesia: A randomized controlled trial

Abstract

Objectives: To compare the effect of remifentanil vs dexmedetomidine on hemodynamic response of noxious stimuli and neonatal outcome in preeclamptic parturient underwent C.S. under G.A. Methods: This blinded, prospective, randomized trial included 50 preeclamptic parturients underwent C.S under G.A., randomized into two equal groups [25 patients each]: group R [remifentanil]: received 1 μg/kg loading and 0.05 μg/kg/min infusion doses and group D [dexmedetomidine] received 1/kg loading and 0.2 μg/kg/h infusion doses. Maternal MAP and HR were assessed before medication (T0), just after induction of GA (TI), just after intubation (TT), two minutes after intubation (TT2), just after skin incision (TS), two minutes after skin incision (TS2), just after delivery of the baby (TD), and at the end of operation (TE). Time between induction and fetal delivery (I-D interval), time between incision of the uterus and delivery (U-D interval), and time between stop of the infusion of the tested drugs and delivery (D-D interval) were recorded. Neonatal Apgar score was recorded at 1 and 5 min and the need for resuscitative measures. Results: Maternal MAP and HR in group R were statistically lower at (TI), (TT), (TT2), (TS) and (TS2). Neonatal Apgar score was statistically lower in group R with higher incidence for tactile stimulation. Conclusion: Both remifentanil and dexmedetomidine were effective on blunting the pressor response to noxious stimuli in severely preeclamptic parturients. While remifentanil was marginally more effective in suppressing the pressor response, dexmedetomidine was safer for the neonates.

Keywords

• Remifentanil
• Dexmedetomidine
• Preeclamptic
• Cesarean section
• General anesthesia