Objective:

To evaluate the impact of remifentanil on maternal and neonatal outcomes during general anesthesia for cesarean section.

Approach:

• Study Design: Conducted a systematic review and meta-analysis following PRISMA guidelines.
• Data Sources: Sourced randomized controlled trials from PubMed, Embase, Web of Science, and Cochrane.
• Data Analysis: Used weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CI) to evaluate associations.

Key Findings:

• The 1-minute Apgar score was significantly lower in the remifentanil group (WMD: −0.35, 95% CI: −0.54 to −0.15).
• Maternal mean arterial pressure (MAP) at intubation was significantly lower in the remifentanil group (WMD: −11.73, 95% CI: −21.46 to −2.00).
• No significant differences were found in the 5-minute Apgar score or other neonatal and maternal outcomes.

Interpretation:

Remifentanil stabilizes maternal blood pressure during tracheal intubation in cesarean sections under general anesthesia but may lower the 1-minute neonatal Apgar score.

Limitations:

• The study included only randomized controlled trials published before December 31, 2025.
• Potential publication bias and heterogeneity among studies were noted.

Conclusion:

Further clinical studies are needed to assess the benefits of remifentanil for neonates.

Sources:

• Systematic Review Registration