International journal of obstetric anesthesia
-
Int J Obstet Anesth · Aug 2019
Observational StudyRemifentanil patient-controlled intravenous analgesia during labour: a retrospective observational study of 10 years' experience.
Intravenous remifentanil patient-controlled analgesia (PCA) has been routinely available for labouring women in our unit since 2004, the regimen using a 40 µg bolus available two minutely on demand, continuous pulse oximetry and mandatory one-to-one care. We examined remifentanil use and compared, with the other analgesic options available in our unit, outcomes such as mode of delivery, Apgar scores, neonatal resuscitation and admission to the neonatal intensive care unit. ⋯ We found remifentanil PCA to be neither less safe nor associated with poorer outcomes than other analgesic options offered in our unit, when used within our guidelines for more than a 10-year period.
-
Int J Obstet Anesth · Aug 2019
Randomized Controlled Trial Comparative StudyA randomised comparison of C-MAC™ and King Vision® videolaryngoscopes with direct laryngoscopy in 180 obstetric patients.
Current evidence suggests that there is uncertainty about which videolaryngoscope performs best in obstetric anaesthesia. The aim of this study was to compare C-MAC and King Vision® videolaryngoscopes and direct laryngoscopy for tracheal intubation of patients undergoing caesarean section. ⋯ Compared to direct laryngoscopy, C-MAC and King Vision® did not prolong the time to intubation, supporting these videolaryngoscopes as primary intubation devices in obstetric anaesthesia. The C-MAC was easier to use and needed fewer additional manoeuvres than the King Vision®. The C-MAC may be better suited for tracheal intubation of obstetric patients undergoing caesarean section.
-
Int J Obstet Anesth · Aug 2019
Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands.
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. ⋯ 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.