Case Series of Vital Signs-controlled, Patient-assisted Intravenous Analgesia (VPIA) Using Remifentanil for Labor and Delivery

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(Anaesthesia. 2017;72(7):845–852)

Intravenous remifentanil patient-controlled analgesia (PCA) is an alternative to epidural analgesia for labor pain management. Compared with other systemic opioids, its unique pharmacokinetic properties make it a preferred alternate analgesic. These properties included fast onset, an ultra-short context-sensitive half-life, and rapid redistribution and elimination by the fetus. Remifentanil is known, however, to cause maternal respiratory depression when used for labor analgesia. This leads to maternal oxygen desaturation in a significant proportion of women, although it is generally short-lived. Rarely respiratory arrest has been reported. It is thus strongly recommended that when administering remifentanil PCA, maternal respiratory rate and oxygen saturation be continuously monitored.

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