Highlights
- •Serious adverse events associated with remifentanil labour analgesia are rare.
- •Strict maternal monitoring during remifentanil administration is essential.
- •The optimal maternal monitoring during remifentanil use is still under discussion.
Abstract
Background
During labour, remifentanil patient-controlled analgesia is used as an alternative
to neuraxial analgesia. Remifentanil is associated with hypoventilation and respiratory
depression but the frequency of serious maternal and neonatal adverse events is unknown.
The aim of this study was to estimate the number of serious adverse events attributed
to the use of remifentanil patient-controlled analgesia during labour in The Netherlands
and to investigate the circumstances (e.g. monitoring, practice deviations) of these
events and the subsequent management.
Methods
In a nationwide survey among obstetricians, anaesthetists and clinical midwives the
frequency of serious adverse events was assessed. A questionnaire was sent by email
to all 61 Dutch hospitals in which remifentanil patient-controlled analgesia is, or
has been, available for labour analgesia. All reported cases were assessed independently
by two expert teams.
Results
We received information from all hospitals. After independent assessments, 17 cases
of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac
arrest; and two neonatal cases of respiratory depression, over a period of more than
10 years of remifentanil patient-controlled analgesia use, were identified as a serious
adverse event. All serious adverse events were resolved without irreversible damage.
Conclusions
The risk of a potentially life-threatening serious adverse event attributed to remifentanil
patient-controlled analgesia seems to be low. All patients recovered without deficit.
Adherence to strict monitoring and the attendance of trained healthcare providers
is required to safely use remifentanil for labour analgesia.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of Obstetric AnesthesiaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Practice Bulletin No. 177: Obstetric Analgesia and Anesthesia.Obstet Gynecol. 2017; 129: e73-e89
NVOG Dutch Society of Obstetrics and Gynaecology. Guideline pain relief during labour (pijnstilling tijdens de bevalling). 2008.
- Intravenous remifentanil: placental transfer, maternal and neonatal effects.Anesthesiology. 1998; 88: 1467-1474
- Pharmacokinetics and pharmacodynamics of remifentanil: an update in the year 2000.Curr Opin Anaesthesiol. 2000; 13: 449-455
CBG. Public Assessment Report Remifentanil (2010).
- Intravenous patient-controlled analgesia for labour: a survey of UK practice.Int J Obstet Anesth. 2007; 16: 221-225
- Analgesia for labour: a survey of Norwegian practice - With a focus on parenteral opioids.Acta Anaesthesiol Scand. 2009; 53: 494-499
- Obstetric analgesia in German clinics. Remifentanil as alternative to regional analgesia.Der Anaesthesist. 2011; 60: 995-1001
- Practice variation in remifentanil during labour; and overview of its application in Dutch hospitals.Ned Tijdschr Geneeskd. 2018; 162 (pii: D2816)
- Epidural analgesia versus remifentanil patient controlled analgesia in labor: a survey of practice in the Netherlands.Int J Clin Anesthesiol. 2016; 4: 1051
Inspectie voor de Gezondheidszorg. Thematisch toezicht geboortezorg: Afsluitend onderzoek naar de invoering van de normen van ‘Een goed begin’. (2016). Available at: https://www.igj.nl/documenten/rapporten/2016/04/19/thematisch-toezicht-geboortezorg-afsluitend-onderzoek-naar-de-invoering-van-de-normen-van-‘een-goed-begin’. Accessed October 5, 2017.
- Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia.Anaesthesia. 2012; 67: 538-540
- Emergency bedside cesarean delivery: lessons learned in teamwork and patient safety.BMC Research Notes. 2012; 5: 412-416
- Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia.Anaesthesia. 2013; 68: 283-287
- Use of remifentanil for labor analgesia: the good and the bad.Anesth Analg. 2007; 104: 1616-1617
- Respiratory arrest with remifentanil patient-controlled analgesia – another case.Anaesthesia. 2012; 67: 1044-1045
- A survey of intravenous remifentanil use for labor analgesia at academic medical centers in the United States.Anesth Analg. 2017; 124: 1208-1210
- Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour.Cochrane Database Syst Rev. 2017; 4: CD011989
- Remifentanil Patient-controlled intravenous analgesia for labor pain relief: is It really an option to consider?.Anesth Analg. 2017; 124: 1029-1031
- Patient-controlled intravenous analgesia remifentanil fot labor analgesia: time to stop, think and reconsider.Curr Opin Anaesthesiol. 2015; 28: 237-239
NVOG Dutch Society of Obstetrics and Gynaecology, NVA Dutch Society of Anaesthesiology, KNOV Dutch Society of Midwifery & NVZA Dutch Society of Hospital Pharmacists. Standard Operation Procedure Remifentanil PCA. (2014)
Lime Survey. Available at: https://www.limesurvey.org/. Accessed October, 2018.
- Analysis of physiological respiratory variable alarm alerts among laboring women receiving remifentanil.Anesth Analg. 2017; 124: 1211-1218
- “Do no harm” – Where to place remifentanil for labour analgesia?.Trends Anaesth Crit Care. 2017; 17: 17-20
- Remifentanil for labor analgesia: an evidence-based narrative review.Int J Obstet Anesth. 2016; 25: 66-74
- Remifentanil during labour; has its place in pain relief during labour been decided?.Ned Tijdschr Geneeskd. 2018; 162 (pii: D1948)
- A prospective observational study of maternal oxygenation during remifentanil patient-controlled analgesia use in labour.Anaesthesia. 2016; 71: 171-176
- Naleving van de ‘Standard Operating Procedure Remifentanil Patient-controlled Analgesia’ in Nederland.Dutch J Obstet Gynaecol. 2018; 131: 294-298
Article info
Publication history
Published online: November 01, 2018
Accepted:
October 26,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
