Effects Of Different Concentrations Of Remifentanil By Target-controlled Infusion On Maternal With Schizophrenia For Cesarean Section

Background: The prevalence of schizophrenia was 0.007%-0.014% in China, and 50% of the schizophrenic patients were between 20-30 years old,which was just the gestational age for women, so there were a certain proportion of maternal schizophrenia. Remifentanil in normal women has been maturely used, but there was little clinical studies information about it when used in anesthesia for cesarean section maternal with schizophrenia. Whether maternal patients with schizophrenia need a larger dose to maintain hemodynamic stability and how it affects fetal respiratory and circulation with a large dose of remifentanil were not still clear.Objective: To explore the most appropriate concentration of remifentanil for maternal with schizophrenia for cesarean section and its effect on mother and fetals by observing the changes of maternal dynamics and concentration of remifentanil in blood of maternal and child with schizophrenia for cesarean section with different concentrations of target-controlled infusion of remifentanil.Methods: 60 cases of primipara with schizophrenia undergoing elective cesarean section under general anesthesia were selected, ASA?or?,Age 22-32 y weight 65-90 kg, 37-39 weeks of gestation. Patients with pathology obstetrics, high- risk pregnancies, multiple births, fetal distress preoperative opioid history of allergy were excluded. All patients showed no abnormal heart and lung liver and kidney function, no premedication, no history of long-term use of opioids. According to the random number table method, the patiens were divided into three groups of 20 people, Low dose group?Group A?,moderate dose group?Group B? and high dose group?Group C??Mothers in Group A, B and C with schizophrenia were admined with intravenous target-controlled infusion of remifentanil, which plasma target concentration were respectively 2ng/ml, 3ng/ml and 4ng/ml.All patients had been fasted for 6-8h, after the patient entranced, monitoration of heart rate?HR?,electrocardiogram?ECG?,pulse oxygen saturation?SpO₂? were added routinely. Keeping left-leaning of 30 degrees supine, and opening the right side upper extremity venous and infusing of sodium lactate ringer at 4-6ml/kg. BIS was connected to monitor the maternals' sedation level. Pure oxygen through a mask 6L/min was available. Under the local anesthesia, puncturing and catheterization in left radial artery was operated to monitor the arterial blood pressure?ABP?. Sufficient oxygen was needed for 3-5mins before induction, then remifentanil was administered by target-controlled infusion to the target plasma concentration while disinfecting. When it got the target concentration, propofol 2mg/kg and rocuronium0.6mg/kg was administered in vein, endotracheal intubation1 was conducted 1.5min later by oral photopic downlink and then connected to the anesthesia machine and regulated the breathing parameters to have a control ventilation. Target plasm concentration of remifentanil was maintained at the target level during the operation and propofol?4-8mg/kg/h? was infusioned continuously to maintain the value of BIS between 45-55.Extracted the parent artery?left radial artery? blood, umbilical arterial and venous blood of the fetus?when breath was not established? for each 2 ml immediately at the point of before and after the fetus delivery, 1ml of the blood was immediately used for blood gas test, another 1ml of the blood sample was placed in a 20?l test tube containing 50% citric acid in-20 ?cryopreservation to be tested. The maternals' systolic blood pressure?SBP??diastolic blood pressure?DBP?, heart rate?HR?, saturation of pulse oxygen?SpO₂? were recorded before the induction of anesthesia?T1??the time skin incisioned?T2?, time the baby delivered?T3?,time the abdomen closed?T4?,and the end of the surgery?T5?. The operation time, the dose of propofol, recovery time after surgery and the extubation time were recorded. Apgar scores at 1 min and 5 min after the birth and neonatal behavioral neurological assessmen?NBNA? scores at 1h, 24 h were recorded. Concentration of remifentanil in maternals' arterial blood and neonatal umbilical arterial and venous blood by capillary gas chromatography-mass spectrometry to estimate the ammont of remifentanil through the placenta to the fetus and the metabolism of remifentanil in the fetus.Result: Each group of maternal were satisfactory with the effect of anesthesia and the fetus were in good condition without resuscitation, and all the test were successfully completed1 There were not statistically significant difference in age, height, weight and gestational weeks between each group of maternale?P>0.05??2 Compared betwen the preoperative, systolic blood pressure, diastolic blood pressure and heart rate of maternals of group A increased at the time of intubation and skin incision?P<0.05?,While during the same experience, there were no respectively chang?P>0.05? in Group B and blood pressure and heart rate drop?P<0.05?in group C.3 The amount of propofol in Group A, Group B and Group C were reduced respectively?P<0.05?.Compared between the groups, there were no statistically significant difference in operative time, fetal childbirth time and time of opening eyes and the amount of propofol in Group A, Group B and Group C were reduced respectively?P<0.05?.4 Compared with Group B, there were not statistically significant difference in Apgar score and neonatal behavioral neurological assessmen in Group A?P>0.05?. Compared with Group A and Group B. Apgar score and neonatal behavioral neurological assessmens score were decreased in Group C?P <0.05?.5 When the baby delivered, the plasma concentration of remifentanil in MA, UV, UA refered to Table 5,and the rate of C_UA/C_UV were respectively 0.47±0.27,0.59±0.07,0.59±0.05 and the rate of C_UA/C_UV were 0.50±0.04,0.48±0.06,0.47±0.06 in Group A, Group B and Group C. Compared with Group B and Group C, the plasma concentration of remifentanil in MA, UV, UA decreased?P<0.05? and the rate of C_UV/C_MA decreased?P<0.05? for maternal in Group A.6 Result of blood gas analysis of the umbilical artery and umbilical venous after birth of fetus referd to Table 6.Compared within the groups, there were no significant statistically difference beteen the value of PH, PCO₂, PO₂ of umbilical artery and umbilical vein blood?P>0.05?.Conclusion:Remifentanil and propofol could be safely used in combination anesthesia of maternal cesarean section with schizophrenia. The plasma target concentration of 3ng/ml was the proper selection in cesarean section for women with schizophrenia.