Remifentanil lowers maternal mean arterial pressure at intubation but may decrease 1-minute Apgar scoresRemifentanil impacts mother and baby health during emergency C-sections

The effects of remifentanil on maternal and neonatal outcomes during general anesthesia for cesarean section have been controversial. Therefore, we conducted a meta-analysis to evaluate the impact of remifentanil on maternal and neonatal outcomes. Following PRISMA guidelines, randomized controlled trials published before December 31, 2025, were sourced from PubMed, Embase, Web of Science, and Cochrane. Two independent researchers screened and extracted data, using weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CI) to evaluate associations. Heterogeneity was assessed with the I² test, along with subgroup and sensitivity analyses. Publication bias was checked using funnel plots and Egger's test. Eleven randomized controlled trials with 645 participants were analyzed, with 323 in the experimental group and 322 in the control group. The 1-minute Apgar score and maternal mean arterial pressure (MAP) at intubation were significantly lower in the remifentanil group, with weighted mean differences of −0.35 (95% CI: −0.54 to −0.15) and −11.73 (95% CI: −21.46 to −2.00), respectively. No significant differences were found in the 5-minute Apgar score or other neonatal and maternal outcomes. Subgroup analysis showed the 1-minute Apgar score was significantly lower in both placebo-controlled and dexmedetomidine-controlled groups compared to the experimental group. Remifentanil can stabilize maternal blood pressure during tracheal intubation in cesarean sections under general anesthesia, but it might lower the 1-minute neonatal Apgar score. There were no significant impacts on the 5-minute Apgar score or respiratory function. Further clinical studies are needed to assess its benefits for neonates. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261342473, PROSPERO CRD420261342473.