Discussion
aching, visceral pain, blood loss, Visceral pain, shivering
NEONATAL RESPIRATORY DEPRESSION, BLOOD LOSS, CONTRACTION, ADVERSE EFFECTS, RESPIRATORY DEPRESSION
The primary finding of our present study was that the intravenous administration of remifentanil increased the number of UEs in parturients undergoing repeated C-section under epidural anesthesia. As expected, intravenous remifentanil might be considered as an effective adjunct to epidural ropivacaine for the relief of visceral pain and improvement of childbirth experience in parturients, with no significant adverse effects in neonates.Visceral pain is described as a dull, aching, ill-defined, and unpleasant feeling that is poorly localized and appears to come from deep within the body, and is frequently accompanied by malaise and strong autonomic reflexes [Remifentanil, a commonly used analgesic in obstetric anesthesia, could provide effective analgesia during monitored anesthesia care in a general patient population with minimal effects on respiration and hemodynamics at dose of 0.1 μg/kg/min [Due to its rapid metabolism, redistribution, or both, the neonatal concentration may not reach a sufficient level to induce fatal neonatal respiratory depression [Moreover, the Ramsay scores of the parturients who received remifentanil were increased significantly, and no subject developed respiratory depression (RR < 8 times/ min) without impairments in oxygen saturation and other vital signs. Continuous intravenous administration of remifentanil had little effect on uterine contraction, given that the dose of oxytocin administration and the total volume of blood loss were comparable between two groups. And, consistent with previous studies, no significant adverse effects on neonates were reported [Up to 85% of parturient undergoing C-section may experience shivering after spinal anesthesia due to an impairment of thermoregulation [Several limitations should be addressed. First, the maximum safe dose of intravenous remifentanil for C-section under epidural anesthesia is undetermined, and we should be aware that adverse outcomes are significant with bolus dose larger than 40 ug or the concomitant use of long-acting opioids [