BJA Advance Access published online on August 19, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei219
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Department of Anaesthesia, St Helier Hospital, Surrey, UK
* To whom correspondence should be addressed. Background. Remifentanil has been suggested as an ideal opioid for patient-controlled analgesia (PCA) in labour, but the safety profile has not been established. The aims of this preliminary prospective observational study were to investigate the maternal side-effects and early neonatal effects, and to assess the placental transfer of remifentanil PCA during labour. Methods. Women with no known obstetric complications or contraindication to remifentanil were recruited (n=50). Remifentanil was administered at a bolus dose of 0.5 µg kg-1 and a lockout period of 2 min. A visual analogue scale was used to assess pain, nausea and itching. Maternal observations were recorded hourly and fetal heart rate trace was assessed every 2 h. Umbilical cord gases, 1 and 5 min Apgar scores and neurological evaluation of the neonate were recorded. Maternal venous blood and umbilical artery and vein cord blood samples were collected for analysis of remifentanil concentration. Results. Fifty women enrolled in the study (24 multiparous, 26 primiparous). There was no evidence of cardiovascular instability or respiratory depression. Pain scores decreased significantly, but there was no significant change in nausea after initiating the PCA. A statistically significant increase in itching was found to be clinically mild and 22 women were slightly drowsy (95% confidence interval [CI], 30-58.7%) but alert to voice. Ten fetal heart rate traces demonstrated changes in the first 20 min, but did not require intervention (95% CI, 10-33.7%). The median 1 and 5 min Apgar scores were 9. The mean umbilical cord gases and neurological examination were within normal limits. Maternal vein and umbilical vein cord samples demonstrated placental transfer of remifentanil, and small amounts were detected in umbilical artery samples. Conclusions. At the bolus dose used remifentanil PCA has an acceptable level of maternal side-effects and minimal effect on the neonate. Remifentanil crosses the placenta and appears to be either rapidly metabolized or redistributed in the neonate.
Accepted April 12, 2005
Clinical Investigation
Maternal and neonatal side-effects of remifentanil patient-controlled analgesia in labour
2 Department of Anaesthesia, St George's Hospital Medical School, London, UK
3 Department of Chemical Pathology, Epsom Hospital Laboratories, West Park Hospital, Surrey, UK
4 Department of Obstetrics and Gynaecology, Glan Clwyd Hospital, North Wales, UK
I. Volikas, E-mail: ivolikas{at}hotmail.com
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. Hinova and R. Fernando Systemic Remifentanil for Labor Analgesia Anesth. Analg., December 1, 2009; 109(6): 1925 - 1929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D'Onofrio, A. M. M. Novelli, F. Mecacci, and G. Scarselli The Efficacy and Safety of Continuous Intravenous Administration of Remifentanil for Birth Pain Relief: An Open Study of 205 Parturients Anesth. Analg., December 1, 2009; 109(6): 1922 - 1924. [Abstract] [Full Text] [PDF]
|
|