A broadening choice for labor analgesia: remifentanil on the á la carte menu

Ronel, Ilai; Weiniger, Carolyn F.

doi:10.1016/j.ijoa.2019.06.005

Cited by 7 publications

(4 citation statements)

References 48 publications

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“…The avaiability of systemic opioid analgesics for labour expands the options for women. 24 Remifentanil PCA appears to provide the most effective non-neuraxial labour analgesia, with high levels of maternal satisfaction and favourable delivery and neonatal outcomes. However, because of the incidence of maternal respiratory depression with remifentanil, illustrated by reports of maternal hypoxia, respiratory arrest, and maternal cardiac arrest, safety consideration is paramount.…”

Section: Discussionmentioning

confidence: 99%

Non-regional analgesia for labour: remifentanil in obstetrics

Ronel

Weiniger

2019

BJA Education

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Section: Discussionmentioning

confidence: 99%

Non-regional analgesia for labour: remifentanil in obstetrics

Ronel

Weiniger

2019

BJA Education

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“…An early epidural placement may reduce the need for general anaesthesia in case of conversion to caesarean delivery 3,36 . Although no pharmacological changes in regular dosing have been recommended, a modified epidural infusion regimen (local anesthetic concentration, adjuvants and/or pump settings) may be considered in order to minimize in-person contact with patients with COVID-19 36 patients with respiratory symptoms such as the increased risk of respiratory depression, as well as the increased risk of vomiting, which could potentially generate aerosols 41 . Remifentanil should be used on a case-by-case basis, and in the absence of respiratory compromise.…”

Section: Intrapartum Analgesiamentioning

confidence: 99%

“…Remifentanil intravenous patient‐controlled analgesia is an analgesic alternative to labor epidurals. Nevertheless, there are important considerations in patients with respiratory symptoms, such as the increased risk of respiratory depression, as well as vomiting, which could potentially generate aerosols 41 . Remifentanil should be used on a case‐by‐case basis and in the absence of respiratory compromise.…”

Section: Pharmacologic Considerations: Impact Of Covid‐19 On Delivery...mentioning

confidence: 99%

Pregnancy and COVID‐19: pharmacologic considerations

D’Souza

Ashraf

Rowe

et al. 2021

Ultrasound in Obstet & Gyne

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Medline, Embase, the Cochrane databases, CINAHL and Scopus were searched from inception until May 14, 2020 using MeSH terms and free text search terms related to "coronavirus infections", "pregnancy", "breastfeeding". This was supplemented with targeted searches of general medical and obstetric journals for publications related to routine, off-label, and investigational medications used in COVID-19 patients either for symptomatic relief or in the context of clinical trials, and discussions with international experts. In addition, we reviewed product monographs of all drugs, and conducted targeted literature searches involving the use of each drug in pregnant women. Finally, clinical practice recommendations were summarized from pregnancy guidelines of international societies and ongoing trials were reviewed from three clinical trial registries-www.clinicaltrials.gov, Australian New Zealand Clinical Trials Registry (ANZCTR) and the World Health Organization International Clinical Trials Registry Platform (ICTRP). Given the limited experience with the management of COVID-19, research letters, editorials, commentaries, opinion pieces and special communications were included. No language restrictions were applied.

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“…Nevertheless, the theoretical and reported growing practical evidence speaks in favour of safe remifentanil use during labour if the established standard procedure is followed, as was recently reported by the authors from RemiPCA SAFE Network (5). Although many obstetric clinics already routinely offer an option of remifentanil as the most effective alternative technique to epidural analgesia (10), a clear consensus about its safe applicability for this indication has not been reached (11,12), and additional research is necessary to determine the safety of remifentanil treatment during labour (13).…”

Section: Introductionmentioning

confidence: 96%

Determination of remifentanil in neonatal dried blood spots by liquid chromatography-tandem mass spectrometry

Trontelj,

Rozman,

Mrhar

2024

Acta Pharmaceutica

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Remifentanil is an ultra-short-acting synthetic opioid-class analgesic which might be increasingly used “off-label” as pain management during labour. Side effects in parturients during labour, and in the infant at birth are of particular concern, especially respiratory depression which is concentration-dependent, and can occur at levels as low as 3–5 ng mL–1. The safety of such use, particularly in newborns due to remifentanil placental transfer, has not been fully demonstrated yet, partly due to the lack of a suitable non-invasive analytical method. The aim of our work was to develop a sensitive method to monitor the levels of remifentanil in neonates by a non-invasive sampling of umbi lical cord blood to support efficacy and safety trials. The presented LC-MS method is sensitive enough to reliably quantify remifentanil in just 20 µL of blood at only 0.3 ng mL–1. The dried blood spot sample preparation included solvent extraction with subsequent solid-phase extraction. The method was validated in terms of accuracy, precision, recovery, matrix effect, and stability, and was successfully applied to a small pilot study. The estimated arterial blood concentrations at the time of delivery ranged from 0.2 to 0.3, and up to 0.9 ng mL–1 in neonatal, and maternal samples, respectively.

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A broadening choice for labor analgesia: remifentanil on the á la carte menu

Cited by 7 publications

References 48 publications

Non-regional analgesia for labour: remifentanil in obstetrics

Non-regional analgesia for labour: remifentanil in obstetrics

Pregnancy and COVID‐19: pharmacologic considerations

Determination of remifentanil in neonatal dried blood spots by liquid chromatography-tandem mass spectrometry

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