Cardiac arrest in an obstetric patient using remifentanil patient‐controlled analgesia

Marr, R.; Hyams, Jeffrey S.; Bythell, V.

doi:10.1111/anae.12099

Cited by 51 publications

(18 citation statements)

References 10 publications

(14 reference statements)

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“…Furthermore, in addition to the safety features mentioned in previous correspondence [1,3], we suggest that an initial 20-lg bolus of remifentanil may be safer in opioidna€ ıve patients. While it is open to debate whether remifentanil PCA should be considered equivalent to central neuraxial analgesia, it was initially introduced to allow dynamic analgesia for women in labour with contraindications to epidural analgesia, without adversely affecting their babies [4].…”

supporting

confidence: 53%

“…Although the case report recently published by Marr and co-authors [1] emphasises important safety aspects when using remifentanil for labour analgesia, we feel the title and summary of the report are misleading as they imply that remifentanil was the problem. A more appropriate (though admittedly less snappy) description might be 'Cardiac arrest in an obstetric patient with diagnosed intrauterine death using concomitant paracetamol, codeine, Entonox, diamorphine plus remifentanil PCA', which emphasises the risk of administering concomitant potent opioids and/or non-opioid analgesics when remifentanil is used.…”

mentioning

confidence: 88%

“…A more appropriate (though admittedly less snappy) description might be 'Cardiac arrest in an obstetric patient with diagnosed intrauterine death using concomitant paracetamol, codeine, Entonox, diamorphine plus remifentanil PCA', which emphasises the risk of administering concomitant potent opioids and/or non-opioid analgesics when remifentanil is used. In the case reported, oral codeine and intramuscular diamorphine had been administered before the remifentanil PCA was initiated, and inhaled Entonox was used during the contractions [1]. A previous report of respiratory arrest after intrauterine death at 26 weeks' gestation [2] also recorded the poorly monitored use of remifentanil 'with occasional … Entonox'.…”

mentioning

confidence: 98%

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Cardiac arrest and remifentanil PCA

Kranke

Smith

2013

Anaesthesia

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supporting

confidence: 53%

mentioning

confidence: 88%

mentioning

confidence: 98%

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Cardiac arrest and remifentanil PCA

Kranke

Smith

2013

Anaesthesia

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“…Bonner et al 53 Respiratory arrest in patient using remifentanil in PCA Marr et al 54 Cardiorespiratory arrest during induced labour while using a remifentanil PCA in patient diagnosed with an intrauterine death at 31 weeks' gestation PCA -Patient controlled analgesia Table 6. Meta-analysis of study results comparing VAS between t=0 and t=1 hour for remifentanil.…”

Section: Referencementioning

confidence: 99%

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

Štourač¹,

Kosinová²,

Harazim³

et al. 2016

BIOMED PAP

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Background and Aims. Although epidural analgesia is still regarded as the gold standard for labour analgesia due to its efficacy, in cases of contraindication, systemic remifentanil is an alternative. Since the first demonstration of the safety of remifentanil in obstetric analgesia in 1996, this has been repeatedly confirmed for both mother and newborn. The aim of this meta-analysis is to evaluate recently published studies (up to December 2014) on the analgesic efficacy of remifentanil during labour (as a Visual Analogue Scale (VAS) decrease in the first hour by 2 or more). Methods. Search of the US National Library of Medicine, National Institutes of Health (www.pubmed.gov), SCOPUS database (www.scopus.com) and Web of Science database (www.webofknowledge.com) using the key words "labour" and "remifentanil". 44 identified articles were included in the review and 15 published randomised controlled studies were incorporated into the meta-analysis. This was based on the fixed model and described by differences in the VAS between t=0 and t=1 hour after remifentanil administration using the 95% confidence interval (CI). The analysis was computed using the Comprehensive meta-analysis version 2.2.064. Results. The combined data from the meta-analysis showed a statistically significant decrease in VAS in the remifentanil group. From a comparison of the CIs of summary estimates with a cut-off decrease of VAS 2, for the fixed model, there was a statistically significantly greater decrease in VAS than the cut-off. In the systematic review, we describe possible modes of application, dosage and side-effects for mother, fetus/ newborn. Conclusion. The meta-analysis presented here confirms that remifentanil for labour analgesia is effective but questions remain which can only be answered by further randomized trials.

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“…Sus características farmacocinéticas lo convierten en alternativa para administrar en PCA en pacientes con contraindicación para la analgesia neuroaxial 65,[74][75][76][77] , aunque se necesitan más estudios para valorar su eficacia y seguridad 78 . El principal efecto adverso es la depresión respiratoria maternal (por tanto se necesita monitorización continua y disponibilidad de oxígeno por si fuese necesario) 79 , habiéndose descrito una parada cardiorrespiratoria 80 . También pueden aparecer náuseas (incidencia variable), prurito moderado (que no suele necesitar tratamiento) 79 y sedación 81 .…”

Section: Opioidesunclassified

Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

Ortiz-Gómez

Palacio-Abizanda

Fornet-Ruiz

2014

Anales Sis San Navarra

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Se insiste en la necesidad de aplicar una aproximación terapéutica multifactorial a la embarazada, no limitándonos solo a eliminar el dolor del parto.Palabras clave: Analgesia obstétrica. Dolor del parto. Epidural. Analgesia controlada por el paciente. Remifentanilo. AbsTrAcTEpidural analgesia is now the method of choice for the treatment of pain in labour and delivery. However, this technique may fail and provide inadequate or null alleviation to the mother. This paper reviews the risk factors, possible causes and possible therapeutic alternatives to inadequate analgesia, whether pharmacological therapies (neuroaxial, peripheral blocks or analgesic administration via intravenous or inhalational routes) or non-pharmacological ones (relaxation techniques, psychological or mechanical).In all possible cases the efficacy and indications of alternative therapies based on the published literature are reviewed, especially from the point of view of evidence-based medicine.The need is underscored of a multifactorial therapeutic approach to the pregnant woman, not just restricting ourselves to eliminating the pain of childbirth.

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Cardiac arrest in an obstetric patient using remifentanil patient‐controlled analgesia

Cited by 51 publications

References 10 publications

Cardiac arrest and remifentanil PCA

Cardiac arrest and remifentanil PCA

The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature

Técnicas analgésicas para el parto: alternativas en caso de fallo de la epidural

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