Intravenous Remifentanil: Placental Transfer, Maternal and Neonatal Effects

Kan, Randall E.; Hughes, Samuel C.; Rosen, Mark A.; Kessin, Charlize; Preston, Paul; Lobo, Errol

doi:10.1097/00132586-199904000-00026

Cited by 115 publications

(170 citation statements)

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“…Propofol and etomidate are good choices for induction, while rocuronium can replace succinylcholine if there are no concerns about the airway. Remifentanil has been shown to be safe for the mother and newborn 18 and could be used pre-or postdelivery as deemed necessary. Fentanyl is a good choice for pain control after delivery as long as pruritus and scratching are well controlled.…”

Section: Discussionmentioning

confidence: 99%

Anesthésie ďune parturiente en travail, atteinte ďurticaire pigmentaire

Villeneuve

Kaufman

Weeks

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: To report the anesthetic management of labour pain and Cesarean section in a patient with urticaria pigmentosa at risk for systemic mastocytosis.Clinical: A 37-yr-old patient with a history of urticaria pigmentosa and an allergic reaction to a local anesthetic agent was seen in consultation at 36 weeks gestation. She previously tested negative for an allergy test to lidocaine. Recommendations to avoid systemic mastocytosis included: avoidance of histamine-releasing drugs, using lidocaine for labour epidural, and regional anesthesia in case of a Cesarean section. The patient presented at term in labour. Intravenous fentanyl was used for early labour, followed by a combined spinal-epidural. The spinal contained lidocaine and fentanyl, but because of pruritus, the epidural infusion contained lidocaine only. Most likely because of tachyphylaxis to lidocaine, an epidural bolus of lidocaine with epinephrine failed to provide adequate anesthesia for a Cesarean section. The block was supplemented with nitrous oxide by mask, with fentanyl postdelivery. Postoperative pain control was managed with an epidural infusion of lidocaine and fentanyl for three days. The patient was discharged without complications four days postsurgery. Conclusion:Proper allergy testing prior to pregnancy is important to help the management of labour pain and anesthesia for Cesarean section in a patient at risk for systemic mastocytosis. U RTICARIA pigmentosa is the cutaneous manifestation of mastocytosis, a disease characterized by the proliferation and accumulation of mast cells in various organs of the body. The incidence of urticaria pigmentosa has been reported to be between 1 in 1,000 and 1 in 8,000 of the population. 1 As many as 10% of patients with urticaria pigmentosa will have systemic Objectif Obstetrical and Pediatric AnesthesiaAnesthetic management of a labouring parturient with urticaria pigmentosa [Anesthésie d'une parturiente en travail, atteinte d'urticaire pigmentaire]

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Section: Discussionmentioning

confidence: 99%

Anesthésie ďune parturiente en travail, atteinte ďurticaire pigmentaire

Villeneuve

Kaufman

Weeks

et al. 2006

Can J Anesth/J Can Anesth

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“…10 They found differences in the maternal pain scores only during the first hour and no differences in the neonatal outcome between the three groups. To date, the literature supports the safety of remifentanil from a neonatal standpoint, 6,7,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] while several studies have shown that fentanyl PCA may be associated with neonatal depression. 1,9,[25][26][27][28] Therefore further research is needed to ensure the safety of these drugs while used for IVPCA in labouring women.…”

Section: Résumémentioning

confidence: 98%

“…Its context-sensitive half-time is about three minutes irrespective of its duration of infusion, 5 and the drug is quickly redistributed and metabolized in the fetus. 6,7 Fentanyl is also a short-acting synthetic opioid with a rapid onset of action (blood-effect site equilibration 6.4 min), but it exhibits cumulative effect with repeated or prolonged administration due to reuptake from inactive tissue sites, which leads to an increase in its context-sensitive halftime. 5,8 The elimination half-life in neonates varies from 75 to 440 min.…”

Section: Résumémentioning

confidence: 99%

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

Marwah

Hassan

Carvalho

et al. 2011

Can J Anesth/J Can Anesth

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Purpose We undertook a retrospective study to compare the analgesic efficacy and effects on neonatal outcome of administering either remifentanil or fentanyl intravenous patient-controlled analgesia (IVPCA) during labour. Methods A five-year retrospective cohort study was undertaken of women with more than 24 weeks of gestation who had received either IVPCA remifentanil or fentanyl for labour analgesia at Mount Sinai Hospital. The sampling timeframe was from November 2005 to March 2010. The standard IVPCA regimen for the remifentanil group consisted of a PCA bolus 0.25 lgÁkg -1 with a lockout interval of two minutes, a four-hour limit of 3 mg, and a background infusion of 0.025-0.05 lgÁkg -1 Ámin -1 , whereas the standard IVPCA regimen for the fentanyl group consisted of a PCA bolus 25-50 lg with a lockout interval of three to six minutes and a four-hour limit of 1-1.5 mg. The following data were compared: maternal hourly pain scores (verbal pain score scale 0-10), sedation scores (scale 0-3), adverse effects, and neonatal outcomes. Mixed linear modelling was used to analyze longitudinal data on pain scores over time. The exact Wilcoxon test and the Fisher's exact test were used for other comparisons.Results Ninety-eight women were studied. There was no significant difference in the model-adjusted pain scores between the two groups (P = 0.86). There was a moderate decrease in pain scores in both groups compared with the baseline values. There was no difference in maternal side effects between the two groups, although transient oxygen desaturation was observed more frequently in the remifentanil group than in the fentanyl group (13% vs 2%, respectively; odds ratio, 7.32; 95% confidence interval [CI], 0.85 to 63.3). A larger number of neonates in the fentanyl group required resuscitation compared with neonates in the remifentanil group (59% vs 25%, respectively; odds ratio, 4.33; 95% CI, 1.75 to 10.76); adjusted (44% vs 8%, respectively; odds ratio, 8.56; 95% CI, 2.17 to 33

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“…Kan et al (1998) studied the basic pharmacokinetics of remifentanil given as an adjunct to epidural anaesthesia for caesarean section. Remifentanil was introduced into obstetric analgesia shortly after this, which was reflected in the publication of the first case reports of effective IV remifentanil analgesia during labour (Brada et al 1998, Jones et al 1999, Thurlow & Waterhouse 2000, Roelants et al 2001.…”

Section: Remifentanilmentioning

confidence: 99%

“…the time needed for a 50% reduction of the concentration in blood after the cessation of infusion that maintains a steady state -is 3 minutes (Kapila et al 1995). The pharmacokinetic study made during anaesthesia for caesarean section showed greater clearance of remifentanil in parturients compared with healthy non-pregnant volunteers (Kan et al 1998). Remifentanil readily crosses the placenta with an umbilical vein (UV) to maternal artery (MA) concentration ratio of 0.73-0.88.…”

Section: Remifentanilmentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Intravenous Remifentanil: Placental Transfer, Maternal and Neonatal Effects

Cited by 115 publications

References 0 publications

Anesthésie ďune parturiente en travail, atteinte ďurticaire pigmentaire

Anesthésie ďune parturiente en travail, atteinte ďurticaire pigmentaire

Remifentanil versus fentanyl for intravenous patient-controlled labour analgesia: an observational study

Intravenous patient-controlled analgesia with remifentanil in early labour

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