A prospective observational study of maternal oxygenation during remifentanil patient‐controlled analgesia use in labour

Abstract

SummaryNumerous studies of remifentanil patient-controlled analgesia during labour have shown high levels of maternal satisfaction, but concerns remain, especially over the side-effects of sedation and respiratory depression. We conducted a prospective observational study of maternal oxygen desaturation during remifentanil patient-controlled analgesia.Pulse oximetry values were recorded every eight s and later downloaded for analysis. A desaturation episode was defined as oxygen saturation < 90%. We collected 148 h of data in 61 women, during which we observed 176 desaturation episodes. These episodes occurred in 43 (70%) women. The median (IQR [range]) of the lowest saturation during each episode was 87 (85-89 [68-89])% with duration 16 (8-24 [8-104]) s. Supplementary oxygen reduced the time per hour spent with saturation < 90%, but not the depth or duration of individual episodes. Desaturation episodes were twice as common during the second stage of labour as compared with the first stage. Prior opioid administration, bolus size and use of nitrous oxide during patient-controlled analgesia use were not found to influence frequency, depth or duration of desaturation episodes. Although these findings suggest desaturation occurs more frequently during remifentanil patient-controlled analgesia than previously reported, the results are comparable with earlier oximetry studies of women who received nitrous oxide and pethidine during labour.

Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands

“…In all those cases, the woman recovered spontaneously. 27 The 17 cases of a single episode of desaturation below 85% in our study are likely to be an underestimation. It is unknown as to what extent one-to-one care is used throughout remifentanil PCA administration in The Netherlands.…”

“…Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands. International Journal of obstetric Anesthesia: 2019, 3, p. [22][23][24][25][26][27][28] The Dutch SOP prescribes requirements for the use of remifentanil PCA, such as education for healthcare providers, the procedure to obtain informed consent, maternal monitoring requirements, preparation for the application of the method, treatment for complications and documentation. Since the literature does not provide an operational definition of an SAE related to remifentanil use, we established our two expert teams.…”

Patient controlled analgesia: effective and cost‐effective management of acute pain within the Emergency Department?

“…One of the clinical trials reported a serious adverse event attributed to respiratory depression in the PCA group , suggesting larger data‐sets are required to identify potentially significant increases in respiratory depression within an ED population. Indeed, a previous study that used continuous pulse oximeter recordings has suggested a high incidence of desaturation episodes with opioid PCA and similar studies in an ED population would be welcomed .…”

Optimising triggers for patient-assisted remifentanil analgesia during labour

“…In addition, we would recommend adding fetal heart rate monitoring that was not included in the VPIA algorithm. Adverse neonatal outcomes with remifentanil administration have been reported in the absence of any maternal respiratory events [3,4], and further steps to improve both maternal and neonatal safety are needed.…”