The Effects of Succinylcholine and Remifentanil on Intubating Conditions in Elective Cesarean Section

Document Type : Original Article (s)

Authors

1 Critical Care Medicine Subspecialist, Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Assistant Professor, Department of Anesthesiology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

3 Department of Anesthesiology, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Associate Professor, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Resident, Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Succinylcholine is the most common muscle relaxant but its side effects resulted in researches for a drug as alternative. The aim of present study was to compare the effects of succinylcholine and remifentanil on intubating conditions in elective cesarean section.Methods: Patients undergoing elective cesarean (n = 200) were enrolled in a double-blinded clinical trial study in Ali Ibne Abitaleb hospital, Zahedan, Iran. Patients were divided in 2 groups of control, received succinylcholine (1.5 mg/kg), and case, received remifentanil (1 µg/kg). Statistical analysis was performed using Fischer’s exact and chi-square tests via SPSS software at the significant level of P < 0.050.Findings: In the succinylcholine group, 92 patients (92%) and in the rhymifentanil group, 76 patients (76%) had good intubation (P < 0.050). Apgar score of 1st minute was less than 7 in 2 (2%) and 14 (14%) newborns in succinylcholine and rhymifentanil groups, respectively (P < 0.050). In case group, Apgar score of 5th minute was seen in 6 newborns (6%), while there was not any case in control group.Conclusion: Our results suggest that with respect to the effect of remifentanil on Apgar, it could be used only in contraindications of succinylcholine in suitable conditions of monitoring and effective resuscitation of neonates.

Keywords


  1. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's anesthesia. 8th ed. Philadelphia, PA: Saunders; 2014. p. 962, 1181, 2345.
  2. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: An overview of systematic reviews. Cochrane Database Syst Rev 2012; (3): CD009234.
  3. Fukuda K. Opioids analgesics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL, editors. Miller's Anesthesia.7th ed. Philadelphia, PA: Churchill Livingstone; 2011. p. 783.
  4. Donati F. Tracheal intubation: Unconsciousness, analgesia and muscle relaxation. Can J Anaesth 2003; 50(2): 99-103.
  5. Birnbach D, Browne I. Anesthesia for obstetrics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL, editors. Miller's anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone; 2011. p. 2214.
  6. Rajan S, Gotluru P, Andews S, Paul J. Evaluation of endotracheal intubating conditions without the use of muscle relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries. J Anaesthesiol Clin Pharmacol 2014; 30(3): 360-5.
  7. Durmus M, Ender G, Kadir BA, Nurcin G, Erdogan O, Ersoy MO. Remifentanil with thiopental for tracheal intubation without muscle relaxants. Anesth Analg 2003; 96(5): 1336-9, table.
  8. Crawford MW, Hayes J, Tan JM. Dose-response of remifentanil for tracheal intubation in infants. Anesth Analg 2005; 100(6): 1599-604.
  9. Morgan JM, Barker I, Peacock JE, Eissa A. A comparison of intubating conditions in children following induction of anaesthesia with propofol and suxamethonium or propofol and remifentanil. Anaesthesia 2007; 62(2): 135-9.
  10. Park BY, Jeong CW, Jang EA, Kim SJ, Jeong ST, Shin MH, et al. Dose-related attenuation of cardiovascular responses to tracheal intubation by intravenous remifentanil bolus in severe pre-eclamptic patients undergoing Caesarean delivery. Br J Anaesth 2011; 106(1): 82-7.
  11. Pournajafian A, Rokhtabnak F, Kholdbarin A, Ghodrati M, Ghavam S. Comparison of remifentanil and fentanyl regarding hemodynamic changes due to endotracheal intubation in preeclamptic parturient candidate for cesarean delivery. Anesth Pain Med 2012; 2(2): 90-3.