International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2019
Remifentanil patient-controlled analgesia in labour: six-year audit of outcome data of the RemiPCA SAFE Network (2010-2015).
In women receiving a remifentanil PCA for labour analgesia, detectable hypoxia occurs in 25% of women and neonatal CPR potentially related to remifentanil in 1 in 300 babies.
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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.
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Int J Obstet Anesth · Aug 2019
Meta AnalysisMetaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials.
Metaraminol is likely superior to ephedrine for managing hypotension due to spinal anaesthesia for Caesarean section, and non-inferior to phenylephrine.
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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.