The use of remifentanil for Cesarean section in a parturient with recurrent aortic coarctation

Purpose: To illustrate the clinical utility of a short acting opioid (remif entanil) based general anesthetic for Cesarean section in a parturient with compromised cardiac function. Clinical Features: A 23-yr-old primigravida, complicated by a recurrent aor tic coarctation with an approximate 50% narrowing of the aortic arch, prese nted for elective Cesarean section at 37 wk gestational age. Initially asym ptomatic, her clinical condition had deteriorated as the pregnancy progress ed, with worsening episodes of mild chest pain and shortness of breath. A s emi-elective Cesarean section under general anesthesia was planned at 37 wk to minimize the potential for aortic complications associated with the hem odynamic stress of labour. Remifentanil was infused at 0.05 to 0.1 mu g.kg( -1).min(-1) with good sedation and analgesia for the placement of invasive monitors. The infusion was increased to 0.2 mu g.kg(-1).min(-1) for inducti on, and combined with isoflurane 0.4 to 0.6% for maintenance of anesthesia. The patient maintained stable hemodynamics throughout and her trachea was extubated without difficulty at the end of the procedure. The newborn did n ot require tracheal intubation, mask ventilation or naloxone and was in exc ellent condition upon transfer to the well baby nursery. Conclusion: Remifentanil, when used as part of an opioid-based general anes thetic for Cesarean section, can provide maternal hemodynamic stability wit h minimal neonatal respiratory depression and should allow for immediate po stoperative tracheal extubation of the mother.