Articles  |   October 2014
SEE Question
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Obstetric Anesthesia / Pain Medicine / Pharmacology / Articles
Articles   |   October 2014
SEE Question
ASA Monitor 10 2014, Vol.78, 46-47.
ASA Monitor 10 2014, Vol.78, 46-47.
A woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and a platelet count of 30,000 is in labor and requesting analgesia. The decision is made to use intravenous (I.V.) remifentanil. Based on a recent study that compared labor analgesia with remifentanil administered as patient-controlled analgesia (PCA) versus continuous infusion, which of the following is most likely true?
Analgesia for labor is commonly provided by epidural infusion of local anesthetics. It is useful to have alternate techniques available, however, when encountering contraindications to neuraxial techniques or difficulty in placement. Parenteral opioids are often the alternative technique offered to laboring parturients. Many opioids and administration techniques have been used, including bolus doses, continuous infusion, and PCA. Since all systemic opioids cross the placenta, however, they can lead to maternal and neonatal respiratory depression as well as decreases in fetal heart rate. Many anesthesiologists have suggested that remifentanil, which has a quick onset time with a constant context-sensitive half-life of just 3.2 minutes, may be an ideal systemic opioid for labor analgesia. The drug has been used for this purpose as a continuous infusion, PCA bolus doses, and a combination of both. The ideal dosing regimen for remifentanil labor analgesia has not yet been determined.
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