| Objective: Reviewing about the maternal and neonatal effects of remifentanil for general anesthesia in women that undergoing Caesarean section and exploring the safety of remifentanil during the Caesarean section.Methods: Systemic literature search was applied in Pubmed et al. for the relevant articles. Randomized, placebo-controlled trials were selected for further investigating. We analysis the haemodynamic response, the Apgar score, the need of neonatal resuscitation and the blood gas analysis of umbilical blood. The random effects model was applied for meta-analysis of continuous and dichotomous variables calculating weighted mean difference or risk ratio and the 95% confidence interval.Results: Nine articles including 523 puerperae were involved in this meta analysis. The highest systolic blood pressure and the fastest heart rate are lower than that in placebo-controlled group[WMD:-42.10 95%CI:(-50.16,-34.04), P<0.00001 and WMD:-16.10 95%CI:(-21.73,-10.47) P<0.00001].The risk ratio of Apgar values under 7 at 1min between two groups has significant difference, the risk ratio is higher in remifentanil-treated group[RR:2.01 95%CI:(1.25, 3.22) P=0.004]. There were not any differences observed in the Apgar values at 5min or the need of airway assist. The p H values of umbilical artery are higher in the remifentanil-treated group with statistically difference[WMD:0.01 95%CI:(0.00, 0.02) P=0.04].Conclusion: The administration of remifentanil in Caesarean section can blunt heart rate and the blood pressure responses to intubation and surgery operation. Although it depresses the respiration of neonate temporarily, the neonate can recover immediately as soon as the remifentanil metabolized or redistributed. Meanwhile it can reduce the incidence of fetal acidaemia. |
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