Caesarean delivery under general anaesthesia (GA) carries nowadays still 25% risk of insufficient depth of anaesthesia in a time before the fetus delivery. The reason is the lack of opioid administration. Opioids easily cross placental barrier and negatively influence newborn postpartum adaptation by respiratory depression. Introduction to GA is thus accompanied by exaggerated autonomic stress reaction with hypertension and tachycardia. The use of ultra-short acting opioid remifentanil should suppress stress response in mother without increasing the risk for newborn. There are only a few clinical data available. This study will be the first one systematically studying the influence of remifentanil in pregnant women with hypertension on hemodynamic stability and newborns safety. This study will also identify potential pharmacogenetic factors of individual variability in remifentanil response with respect of drug efficacy and safety in mother and newborn.
Name: RemifentanilDescription: bolus of remifentanil 1 µg/kg will be given 30 sec before induction to general anesthesiaType: Drug
Description: newborn status (Apgar score + acid-base measurement from umbilical cord, clinical evaluation and scoring)Measure: Newborn adaptation after delivery Time: 10 min after delivery
Description: BIS (continuous bispectral EEG analysis)Measure: Depth of anesthesia Time: 30 min from induction to general anesthesia
Description: Changes in major hemodynamic parameters (Systolic Blood Pressure, Heart Rate, ST analysis)Measure: Hemodynamic response to intubation and beginning of Cesarean operation Time: 30 min from induction to general anesthesia
There is one SNP
Method for assessment of opioid receptor polymorphism (A118G) will be implemented during the first year of the study. --- A118G ---