SP22.1 Remifentanil PCIA has no place in labor analgesia

Abstract

usually feasible for an epidural catheter to be re-inserted in an emergency. It also requires the anaesthesiologist to explain this additional procedure to the patient and gain informed consent in a challenging situation. This extra workload i.e., explaining, gaining informed consent, and inserting a spinal anaesthetic, may be stressful for the anaesthesiologist. Also, they are now required to perform a procedure in a time-pressured and high-stakes environment. Performance anxiety may also play a part if the anaesthesiologist is very keen to avoid a general anaesthetic, for example, if they feel the patient's airway looks particularly difficult or the patient has pre-eclampsia and would therefore be at a higher risk of complications.Patient perspectives should also be considered. The author has found no published literature specifically relating to patient preference regarding epidural or spinal anaesthesia for emergency Caesarean section. However, it is reasonable to think that a patient who has a working labour epidural already has confidence in the technique and as a result, may feel more reassured with epidural anaesthesia for emergency Caesarean section as compared to alternatives.In summary, labour epidurals providing satisfactory analgesia should be considered for a top up to provide epidural anaesthesia for emergency Caesarean sections. In fact, this is one of the main benefits of siting labour epidurals in patients who are at a higher risk for Caesarean section and is a strong feature of obstetric anaesthesia practice using the principles of Planning, Preparation and Pre-emption. In addition, there are disadvantages to the alternative of removing the labour epidural and using a spinal anaesthetic. Furthermore, there are cost, environmental, anaesthesiologist, and patient considerations that may support the choice of epidural anaesthesia over spinal. REFERENCES1. National Institute for Health and Care Excellence (Great Britain). Intrapartum care for women with existing medical conditions or obstetric complications and their babies.

Determination of remifentanil in neonatal dried blood spots by liquid chromatography-tandem mass spectrometry

“…Nevertheless, the theoretical and reported growing practical evidence speaks in favour of safe remifentanil use during labour if the established standard procedure is followed, as was recently reported by the authors from RemiPCA SAFE Network (5). Although many obstetric clinics already routinely offer an option of remifentanil as the most effective alternative technique to epidural analgesia (10), a clear consensus about its safe applicability for this indication has not been reached (11,12), and additional research is necessary to determine the safety of remifentanil treatment during labour (13).…”