Hypertension control during caesarean section in patients with pre-eclampsia: is dexmedetomidine an option?

Possibility to use quanadex (dexmedetomidine) for caesarean section in patients with pre-eclampsia

A prospective, double­blind, randomized, con­trolled clinical trial was conducted at the Republican Spe­cialized Scientific and Practical Medical Center of Obstet­rics and Gynecology of the Ministry of Health of the Repub­lic of Uzbekistan. The inclusion criteria for pregnant wom­en in the study was preeclampsia. All women were divided into 2 groups. In group I, premedication was performed on the table with sibazon 5 mg. In group II, starting from the moment of premedication, 0.5 µg/kg of quanadex (Yuriya Pharm) was administered intravenously for 15 minutes. The maintaining dose was 0.5–0.8 µg/kg/h. 0.5 % hyper­baric longocaine heavy was administered intrathecally at the LII–LIV level. Hemodynamics was assessed by echocardi­ography. BAC and electrolytes, lactate, glucose, hematocrit were studied on a gas analyzer “BGA­102” Wondfo (Rain Sen Da), NTproBNP, Cystatin­C, interleukin­6 and protein S­100 were determined on an immunofluorescence ana­lyzer Finecare™ FIA MeterPlus/FS 113 (Wonfo), sedation was assessed using the Richmond scale. Newborns were assessed for Apgar scores in the 1st and 5th minutes.The data obtained showed that patients randomized to the group with dexmedetomidine (Group II) were almost al­ways better able to awaken than patients in the group with sibazon, and were distinguished by better hemodynamic stability, antinociceptive protection for surgical and anes­thetic intervention, without pronounced arterial hypoten­sion and bradycardia. It did not cause significant adverse outcomes in newborns.

Preeclampsia in 2021-a Perioperative Medical Challenge for the Anesthesiologist

The authors provide a review of recent advances in the understanding of pathophysiology and perioperative management of preeclampsia and eclampsia, from the perspective of the anesthesiologist. This review includes aspects of assessment of severity of disease, hemodynamic monitoring, peripartum anesthesia care, and postpartum management. The perioperative management of patients with eclampsia is also discussed.

Effect of intravenous dexmedetomidine and remifentanil on neonatal outcomes after caesarean section under general anaesthesia: A systematic review and meta-analysis

BACKGROUND

Various strategies have been used to mitigate haemodynamic instability during general anaesthesia for caesarean section. However, the safety of these strategies for neonates remains controversial.

OBJECTIVE

To investigate the effects of intravenous dexmedetomidine and remifentanil on neonatal outcomes during caesarean section under general anaesthesia.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Databases of PubMed, EMBASE and CENTRAL were searched until March 2020 and updated in February 2021.

ELIGIBILITY CRITERIA

Randomised controlled trials were included if they compared dexmedetomidine and remifentanil infusion on neonatal outcomes after elective caesarean section under general anaesthesia. Primary outcomes were 1 and 5 min Apgar scores. Secondary outcomes were the incidence of neonatal mask ventilation or endotracheal intubation, and pH of the umbilical artery and vein. Studies that did not report primary outcomes were excluded.

RESULTS

Five studies with 258 patients in total were included. The Apgar score at 1 min in the remifentanil group was lower than that in the dexmedetomidine group for both quantitative [weighted mean difference (WMD): 0.75; 95% CI, 0.44 to 1.07; τ2 = 0.00] and categorical outcomes (≥Apgar 7 vs.

CONCLUSION

In our study, Apgar score at 1 min reported using both quantitative and categorical variables were lower in the remifentanil group than in the dexmedetomidine group but TSA showed that these differences were inconclusive for categorical variables. Data for other outcomes were scarce and did not allow any conclusions to be drawn. Thus, further studies with larger numbers of parturients and with neonatal outcomes as a primary endpoint are warranted to clarify the effects of intravenous dexmedetomidine and remifentanil.

TRIAL REGISTRATION

The protocol of this study has been registered in PROSPERO (CRD42019141102).

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MESH Headings

• Anesthesia, General/adverse effects
• Cesarean Section
• Dexmedetomidine/adverse effects
• Female
• Humans
• Infant, Newborn
• Piperidines/adverse effects
• Pregnancy
• Remifentanil

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Affiliation(s)

Myeongjong Lee From the Department of Anesthesiology and Pain Medicine (ML), Research Institute of Medical Science, Konkuk University School of Medicine, Chungju (ML), Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul (HK), Department of Anesthesiology and Pain Medicine, Wonkwang University School of Medicine, Muwang-ro, Iksan (CL) and Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea (HK)
Hyungtae Kim
Cheol Lee
Hyun Kang

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