David Hill1. 1. Department of Anaesthesia, Ulster Hospital, Belfast, UK. davidhill@doctors.org.uk
Abstract
PURPOSE OF REVIEW: The present study summarizes the knowledge to date of the use of remifentanil in obstetric anaesthesia and analgesia. RECENT FINDINGS: Modest labour analgesia, particularly for the first stage, can be achieved using a patient-controlled analgesia bolus of 40 microg with a 2-min lockout. Neonatal effects are minimal; however, maternal desaturation is a possibility and requires one-to-one supervision and appropriate monitoring. Background infusions can improve analgesia, but maternal desaturation or even apnoea is more likely. Remifentanil is effective at obtunding responses to airway manipulation and surgery under general anaesthesia. Neonatal effects are more pronounced and 50% of neonates may need assisted ventilation, and occasionally naloxone. SUMMARY: Remifentanil has a place in obstetric anaesthesia and analgesia. Further studies are needed to confirm if background infusions are safe in addition to patient-controlled analgesia. Studies are needed to establish a dose range under general anaesthesia that prevents neonatal respiratory depression at birth.
PURPOSE OF REVIEW: The present study summarizes the knowledge to date of the use of remifentanil in obstetric anaesthesia and analgesia. RECENT FINDINGS: Modest labour analgesia, particularly for the first stage, can be achieved using a patient-controlled analgesia bolus of 40 microg with a 2-min lockout. Neonatal effects are minimal; however, maternal desaturation is a possibility and requires one-to-one supervision and appropriate monitoring. Background infusions can improve analgesia, but maternal desaturation or even apnoea is more likely. Remifentanil is effective at obtunding responses to airway manipulation and surgery under general anaesthesia. Neonatal effects are more pronounced and 50% of neonates may need assisted ventilation, and occasionally naloxone. SUMMARY:Remifentanil has a place in obstetric anaesthesia and analgesia. Further studies are needed to confirm if background infusions are safe in addition to patient-controlled analgesia. Studies are needed to establish a dose range under general anaesthesia that prevents neonatal respiratory depression at birth.