Efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section

Objective To investigate the efficacy of remifentanil-propofol-atracurium combined anesthesia for caesarean section. Methods Forty ASA Ⅰ or Ⅱ patients, aged 24-30 yr, weighing 60-89 kg, at 38-41 week gestation, scheduled for elective cesarean section under general anesthesia, were studied. Remifentanil 1 μg/kg was slowly injected iv and then infused iv at a rate of 0.15 μg·kg-1·min-1 until the end of operation. Propofol 1.5 mg/kg and atracurium 0.6 mg/kg were injected in turn 30 s after remifentauil injection. Mechanical ventilation was performed after tracheal intubation. Atracurium 0.3 mg/kg was intermittently injected iv. Blood samples were taken from umbilical artery (UA) within 1 min after the delivery of the baby for blood gas analysis. Blood samples were simultaneously drawn from UA, umbilical vein (UV), and maternal artery (MA) for determination of plasma remitentanil concentrations (CUA, CUV and CMA) using gas chromatography-mass spectrometry. Systolic blood pressure (SP), diastolic blood pressure (DP), MAP and HR were monitored and recorded before intubation, at the time of inserting the catheter, at skin incision, and at the time of extubation. The analepsia time and satisfactory rate of patients were also recorded. The patient's awareness during operation was noted after operation. Apgar score was performed at 1, 5 and 10 min after the delivery of the newborn. The neonatal behavioral neurological assessment (NBNA) was conducted 1 and 24 h after the delivery of the baby. Results The hemodynamics was stable and varied within the normal range at each time point in all the patients. The analepsia time was (5±4) min and no awareness during operation occurred after postoperative follow-up. The pH value, PaCO2, PaO2 and SaO2 were in the normal range in the neonatal umbilical arterial blood samples. The neonatal Apgar scores at 1, 5 and 10 min after the delivery of the baby were more than 7. NBNA scores were normal. CUV, CUA and CMA were (0.65±0.14), (0.22±0.09) and (0.86±0.25) ng/ml respectively. CUV/CMA and CUA/CUV were 0.7±0.4 and 0.35±0.11 respectively. Conclusion The remifentanil-propofol-atracurium combined anesthesia can produce good anesthetic effect in the patients undergoing cesarean section, with high safety. Key words: Piperidinos;  Propofol;  Atracurium;  Cesarean section