Uso del remifentanilo en bolus en la cesárea de la paciente de alto riesgo: Estudio sobre 12 casos

-1 de remifentanilo, despues, propofol (2,5 mg kg -1 ), succinilcolina (1 mg kg -1 ), cisatra- curio, sevoflurano-O2 - N2O y 5 μg kg -1 de fentanilo tras la ligadura del cordon. Registramos los valores hemodi- namicos maternos, pulsioximetria, capnografia, indice biespectral, presencia de rigidez muscular. En el neona- to valoramos el bienestar fetal, peso y necesidad de nalo- xona. Consideramos estabilidad hemodinamica cuando la presion arterial no variaba mas del 15% respecto al basal. RESULTADOS: Incluimos 12 pacientes con indicacion quirurgica por abruptio placentae, hemorragia subarac- noidea, sindrome HELLP y preeclampsia. Observamos resultados concordantes con estabilidad hemodinamica en todas las pacientes durante la cirugia. Ningun neona- to presento rigidez ni necesito naloxona. El test de Apgar al minuto fue 6,42±1,5 y 8,42±0,9 a los 5 min. CONCLUSION: El remifentanilo en bolo de 1 μg kg -1 -1 ) after clamping the umbilical cord. We recorded maternal hemodynamic variables, pulse oximetry, capnography, bispectral index, and presence of muscular rigidity. In the neonate we assessed fetal well- being, weight, and requirement for naloxone. Hemodynamic stability was defined as no more than 15% variation in arterial pressure with respect to baseline. RESULTS: Twelve patients undergoing surgery because of placenta abruptio, subarachnoid hemorrhage, HELLP syndrome, or preeclampsia were enrolled. Hemodynamic variables were consistently stable during surgery in all patients. No cases of neonatal rigidity were noted and there was no need for naloxone. The mean Apgar score was 6.42 (1.5) at 1 minute and 8.42 (0.9) at 5 minutes. CONCLUSION: Bolus injection of 1 μg·kg -1 of remifentanil may be useful for maintaining maternal hemodynamic stability in high-risk obstetric cases. Given the risk of neonatal depression, this resource should be used selectively and the means for neonatal resuscitation should be available.