Maternal and Neonatal Effects of Remifentanil at Induction of General Anesthesia for Cesarean Delivery

Kee, Warwick D. Ngan; Khaw, Kim S.; Kwok, Cynthia; Wong, April S. Y.; Lee, Bee B.; Ng, Floria F.

doi:10.1097/00000542-200601000-00004

Cited by 149 publications

(120 citation statements)

References 19 publications

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“…In such cases, however, hemodynamic responses to ETI are unavoidable. Because of transient delayed respiratory depression with higher doses of remifentanil was noted in some newborns (17)(18)(19)(20), in the current study safe dose of this drug that had been previously used in labor, was considered. Opioids was also used in epidural space in pregnant women for cesarean section without significant difference in maternal complications and Apgar scores (21).…”

Section: Methodsmentioning

confidence: 99%

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

Pournajafian¹,

Rokhtabnak²,

Kholdbarin³

et al. 2012

anesthpain

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Section: Methodsmentioning

confidence: 99%

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

Pournajafian¹,

Rokhtabnak²,

Kholdbarin³

et al. 2012

anesthpain

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“…Remifentanil readily crosses the placenta with an umbilical vein (UV) to maternal artery (MA) concentration ratio of 0.73-0.88. There is either rapid metabolism of the drug in the foetus or a large volume of distribution as the umbilical artery (UA): UV is 0.29-0.6, both of these mechanisms being consistent with the pharmacokinetics of remifentanil in neonates (Kan et al 1998, Ngan Kee et al 2006, Ross et al 2001.…”

Section: Remifentanilmentioning

confidence: 77%

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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“…Sideeffects, especially drowsiness, were higher in the group with the variable bolus. Apropos the pharmacokinetics of remifentanil and the character of labour pain, initiation of remifentanil administration with the beginning of contraction may not lead to the greatest effect at the time of the most intensive labour pain 47,48 . For this reason, Volmanen et al investigated remifentanil administration either at the beginning of contraction or between two contractions 49 .…”

Section: Comparison Of Different Modes Of Administration Of Remifentanilmentioning

confidence: 99%

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

Štourač¹,

Kosinová²,

Harazim³

et al. 2016

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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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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Maternal and Neonatal Effects of Remifentanil at Induction of General Anesthesia for Cesarean Delivery

Cited by 149 publications

References 19 publications

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

Intravenous patient-controlled analgesia with remifentanil in early labour

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

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