{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:21:13Z","timestamp":1789129273760,"version":"build-2803163510"},"reference-count":30,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Remifentanil may be useful during general anesthesia for cesarean delivery, although the amount administered before delivery using target-controlled infusion (TCI) at different effect-site targets has not been well quantified. This pharmacokinetic study investigated how much remifentanil would be delivered before birth at different initial effect-site targets. Methods: This retrospective simulation study used demographic data from 50 women undergoing cesarean delivery. Remifentanil TCI (Minto model) was simulated with initial effect-site targets of 1, 2, 4, and 6 ng\/mL. One minute after the simulated plasma peak, the target was reduced to 1 ng\/mL (t0). Doses before t0, duration of the infusion pause, and total dose before delivery were calculated. Simulated dosing patterns were summarized overall and stratified by elective and emergency procedures. Results: Infusion pauses after target reduction lasted 175, 346, and 503 s after initial targets of 2, 4, and 6 ng\/mL, respectively. Delivery occurred during these pauses in 16%, 46%, and 72% of cases (19%, 71%, and 90% in emergency cases). Mean remifentanil dose at delivery was 33.7, 43.0, 70.0, and 101.0 \u03bcg for initial targets of 1, 2, 4, and 6 ng\/mL, respectively. Following target reduction, the additional remifentanil administered before delivery decreased from a mean of 17.0 \u03bcg with an initial effect-site target of 1 ng\/mL to 0.9 \u03bcg with an initial target of 6 ng\/mL. Conclusions: This simulation demonstrated that only modest additional doses of remifentanil would be delivered to the mother between induction and delivery during target-controlled infusion for cesarean delivery, with the exact amount depending on the initial effect-site target concentration.<\/jats:p>","DOI":"10.3390\/jcm15187054","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:51:37Z","timestamp":1789123897000},"page":"7054","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacokinetic Simulation of Remifentanil Dosing at Different Effect-Site Targets During Target-Controlled Infusion for Cesarean Delivery"],"prefix":"10.3390","volume":"15","author":[{"given":"Ilja","family":"Osthoff","sequence":"first","affiliation":[{"name":"Spital Thurgau, 8501 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Monica","family":"Soare","sequence":"additional","affiliation":[{"name":"Spital Thurgau, 8501 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Franz-Josef","family":"Vogl","sequence":"additional","affiliation":[{"name":"Spital Thurgau, 8501 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1458-6121","authenticated-orcid":false,"given":"JoEllen","family":"Welter","sequence":"additional","affiliation":[{"name":"Spital Thurgau, 8501 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1456-6457","authenticated-orcid":false,"given":"Alexander","family":"Dullenkopf","sequence":"additional","affiliation":[{"name":"Spital Thurgau, 8501 Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"256","DOI":"10.17085\/apm.22196","article-title":"General anesthesia for cesarean section: Are we doing it well?","volume":"17","author":"Choi","year":"2022","journal-title":"Anesth. 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