Successful reversal of cardiac arrest in the course of remifentanil obstetric analgesia using naloxone: Case report and retrospective audit
Authors:
A. Aboši 1; I. Křikava 2; L. Gábor 1; J. Klučka 2; K. Aboši 1; H. Harazim 3; M. Kosinová 3; H. Zelinková 4; P. Štourač 2
Authors‘ workplace:
Anesteziologicko-resuscitační oddělení, Nemocnice Sokolov
1; Klinika dětské anesteziologie a resuscitace, Fakultní nemocnice Brno, Lékařská fakulta, Masarykova
univerzita
2; Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Brno, Lékařská fakulta
Masarykova univerzita
3; Institut biostatistiky a analýz, Lékařská fakulta, Masarykova univerzita
4
Published in:
Anest. intenziv. Med., 28, 2017, č. 4, s. 240-247
Category:
Overview
Study objective:
The aim of this article is to highlight the rare serious complication of labour analgesia with remifentanil, describe its solution and provide an overview of the efficacy and safety of remifentanil in 2012−2014 in the hospital, where the use of remifentanil in childbirth is a the analgesic method of choice.
Study design:
Case report and retrospective audit.
Setting:
Regional Hospital.
Material and methods:
With the approval of the Ethics Committee Karlovy Vary Regional Hospital we aimed to enroll parturients who laboured in the Sokolov Hospital and their labour pain was relieved with remifentanil. The objective was to verify whether the application of labour analgesia with remifentanil will decrease pain intensity by 2 or more based on the visual analogue scale. Maternal satisfaction with the analgesic method was evaluated by five-percentile range. All complications associated with the analgesia were recorded.
Results:
We enrolled 66 parturients (13−39 years) in the period 2012−2014. There was a statistically significant difference in pain intensity after the remifentanil administration (decrease VAS ≥ 2, p = 0.006). Satisfaction with the analgesic method was 82.4%. Except of described case report of cardiac arrest with successful administration of naloxone during resuscitation, there were no serious complications associated with the application of remifentanil labour analgesia.
Conclusion:
Introduced regimen of obstetric analgesia with remifentanil led to the reduction in the intensity of labour pain at a high rate of maternal satisfaction. Case report pointed out the need for availability of remifentanil antidote in the delivery room and on the importance of rapid availability of anaesthesia team.
Keywords:
remifentanil − labour analgesia − patient controlled analgesia − cardiac arrest − peripartum resuscitation
Sources
1. Ortiz-Gómez JR, Palacio-Abizanda FJ, Fornet-Ruiz I. Analgesic techniques for labour: alternatives in case of epidural failure. An Sist Sanit Navar. 2014;37:411−427. [Článek ve španělštině]
2. Stourac P, Kosinova M, Harazim H, Huser M, Janku P, Littnerova S, Jarkovsky J. The analgesic efficacy of remifentanil for labour. Systematic review of the recent literature. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016;160:30−38.
3. Štourač P, Bláha J, Nosková P, Klozová R, Seidlová D, Jarkovský J, Zelinková H. Analgezie u porodu v České republice v roce 2011 z pohledu studie OBAAMA-CZ – prospektivní observační studie. Čes Gynek. 2015;80:125−132.
4. Štourač P, Bláha J, Nosková P, Grochová M, Firment J, Schwarz D. OBAAMA-INT Study Group. Preferred techniques for obstetric anaesthesia and analgesia in Czech and Slovak Republic in the year 2015 – prospective observational survey. Eur J Anaesthesiol. 2016;33(e-Suppl. 53):182.
5. Bonner JC, McClymont W. Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2012;67:538−540.
6. Marr R, Hyams J, Bythell V. Cardiac arrest in an obstetric patient using remifentanil patient-controlled analgesia. Anaesthesia. 2013;68:283−287.
7. Kranke P, Smith AF. Cardiac arrest and remifentanil PCA. Anaesthesia. 2013;68:640.
8. Melber A, Girard T, Baeriswyl M, Knessl P, Savoldelli G, Board Members of the Swiss Association of Obstetric Anaesthesia. Remifentanil patient-controlled analgesia for labour: learning points from a registry. Int J Obstet Anesth. 2016;27:89−90.
9. Štourač P, Suchomelová H, Stodůlková M, et al. Comparison of Parturient-Controlled Remifentanil with Epidural Bupivacain and Sufentanil for Labour Analgesia: Randomised Controlled Trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014;158:227−32.
10. Blair JM, Dobson GT, Hill DA, McCracken GR, Fee JP. Patient controlled analgesia for labour: a comparison of remifentanil with pethidine. Anaesthesia. 2005;60:22−27.
11. Roelants F, De Franceschi E, Veyckemans F, Lavand‘homme P. Patient-controlled intravenous analgesia using remifentanil in the parturient. Can J Anaesth. 2001;48:175−178.
12. Glass PS, Iselin-Chaves IA, Goodman D, Delong E, Hermann DJ. Determination of the potency of remifentanil compared with alfentanil using ventilatory depression as the measure of opioid effect. Anesthesiology. 1999;90:1556−1563.
13. McAuliffe F, Kametas N, Costello J, Rafferty GF, Greenough A, Nicolaides K. Respiratory function in singleton and twin pregnancy. BJOG. 2002;109:765–769.
14. Hignett R, Fernando R, McGlennan A, McDonald S, Stewart A, Columb M, Adamou T, Dilworth P. A randomized crossover study to determine the effect of a 30 degrees head-up versus a supine position on the functional residual capacity of term parturients. Anesth Analg. 2011;113:1098–1102.
15. Tanoubi I, Drolet P, Donati F. Optimizing preoxygenation in adults. Can J Anesth. 2009;56:449–466.
16. Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A Randomized Controlled Trial of the Efficacy and Respiratory Effects of Patient-Controlled Intravenous Remifentanil Analgesia and Patient-Controlled Epidural Analgesia in Laboring Women. Anesth Analg. 2014;118:589−597.
17. Douma MR, et al. Obstetric analgesia: a comparison of patient-controlled meperidine, remifentanil, and fentanyl in labour. Br J Anaesth. 2010;104:209−215.
18. Leong WL, Sng BL, Sia AT. A comparison between remifentanil and meperidine for labor analgesia: a systematic review. Anesth Analg. 2011;113:818−825.
19. Arfeen Z, Armstrong PJ, Whitfield A. The effects of Entonox and epidural analgesia on arterial oxygen saturation of women in labour. Anaesthesia. 1994;49:32−34.
20. Griffin RP, Reynolds F. Maternal hypoxaemia during labour and delivery: the influence of analgesia and effect on neonatal outcome. Anaesthesia. 1995;50:151−156.
21. Befort K. Interactions of the opioid and cannabinoid systems in reward: Insights from knockout studies. Front Pharmacol. [online] 2015 Feb 5; 6(6). Dostupný z: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318341/pdf/fphar-06-00006.pdf
22. Kranke P, Girard T, Lavand – homme P, Melber A, Jokinen J, Muellenbach RM, Wirbelauer J, Hönig A. Must we press on until a young mother dies? Remifentanil patient controlled analgesia in labour may not be suited as a “poor man's epidural”. BMC Pregnancy Childbirth. 2013;13:139.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
2017 Issue 4
Most read in this issue
- Rapid sequence induction in the Czech Republic 2016: Survey
- Aspiration of gastric contents while using the i-gel laryngeal mask: Case report of three cases
- Atrial fibrillation in critically ill patients
-
Preoperative assessment using mobile technologies in the Czech Republic – are our patients ready for it?
Prospective, observational, multicentre, cross-sectional study