Cardiac Arrest in an Obstetric Patient Using Remifentanil Patient-controlled Analgesia

Abstract

Summary This case report describes the management of a patient, diagnosed with an intrauterine death at 31 weeks’ gestation, who suffered a cardiorespiratory arrest during her induced labour while using a remifentanil PCA. She made a full recovery from resuscitation which included a peri‐mortem caesarean section.

Cardiac arrest and remifentanil PCA

“…Furthermore, in addition to the safety features mentioned in previ-ous correspondence [1,3], we suggest that an initial 20-lg bolus of remifentanil may be safer in opioid-na€ 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].…”

Who knows how many anaesthetists we need?

“…The third article is a case report of cardio-respiratory arrest associ-ated with remifentanil PCA [5]. This is now the fourth case report of respiratory and/or cardiac arrest related to remifentanil in obstetrics published in the last year [5][6][7][8]. Why the sudden flurry?…”

“…Two are concerned with establishing the best method of administration: Shen et al compare patient-controlled analgesia (PCA) with continuous infusion [3], and Jost et al demonstrate a novel approach of a patient-altered variable PCA dose [4]. The third article is a case report of cardio-respiratory arrest associ-ated with remifentanil PCA [5]. This is now the fourth case report of respiratory and/or cardiac arrest related to remifentanil in obstetrics published in the last year [5][6][7][8].…”

Patient-controlled intravenous analgesia remifentanil for labor analgesia

“…However, significant concern has been raised over the last couple of years that remifentanil PCIA during labor can cause potentially lethal respiratory arrest. Several case reports have been published since 2012 in which the administration of remifentanil PCIA resulted in respiratory arrest and/or cardiac arrest [13][14][15]. Several factors contributed to the remifentanil-induced morbidity such as previous opioid administration (O'Kinney et al and Marr et al) or erroneous drug dosing (O'Kinney et al).…”