Serious adverse events att ributed to remifentanil patient controlled analgesia during labour in The Netherlands

Geplaatst op

Remifentanil patient controlled analgesia is widely used for labour analgesia as an alternative for epidural analgesia. Remifentanil is associated with hypoventilation and respiratory depression but the frequency of serious maternal and neonatal adverse events is unknown.

The aim of this study was to estimate the number of serious adverse events attributed to the use of remifentanil patient controlled analgesia for labour analgesia in The Netherlands and to investigate the circumstances of these cases and the procedures followed.

Methods: In a nationwide survey among gynaecologists/obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was measured. A questionnaire was sent by email to all 61 Dutch hospitals in which remifentanil patient controlled analgesia is or has been available for labour analgesia. All reported cases were assessed by two expert teams independently.

Results: We received information from all hospitals. After the assessments of both expert teams ten maternal cases of apnea, bradycardia and/or cardiac arrest and two neonatal cases of respiratory depression over a period of more than ten years of remifentanil patient controlled analgesia use were identified as a serious adverse event. The estimated risk of a maternal and neonatal serious adverse event was respectively less than 1:14,000 and 1:43,000 deliveries. All serious adverse events were solved without irreversible damage.

Conclusions:The risk for a serious adverse event attributed to remifentanil patient controlled analgesia is extremely low. All patients recovered without deficit. The adherence to strict monitoring and the attendance of trained healthcare providers are required to safely use remifentanil patient controlled analgesia.

Doel

The aim of this study was to estimate the number of serious adverse events attributed to the use of remifentanil patient controlled analgesia for labour analgesia in The Netherlands and to investigate the circumstances of these cases and the procedures followed.

Conclusies

The risk for a serious adverse event attributed to remifentanil patient controlled analgesia is extremely low. All patients recovered without deficit. The adherence to strict monitoring and the attendance of trained healthcare providers are required to safely use remifentanil patient controlled analgesia.

Uitvoerder(s)

SLM. Logtenberg

Contactpersonen

SLM. Logtenberg

Publicaties

Int J Obstet Anesth. 2018 Nov 2



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