title: Remifentanil target-controlled infusion during second stage labour in high-risk parturients: a case series.
abstract: BACKGROUND
  Providing adequate analgesia and appropriate sedation to high-risk parturients during late second stage labour without compromising foetal safety remains a major challenge, especially in situations when neuraxial block is not applicable. Remifentanil emerged as an option for labour analgesia during the last decade but may be suitable for the facilitation of complicated vaginal deliveries as well.
  
  
  METHODS
  A retrospective chart review of nine labouring women with significant medical and/or obstetrical risk factors was conducted. According to the assessment of an experienced obstetrician, vaginal delivery could only be achieved with profound analgesia, and neuraxial block was not possible because of contraindications, technical failure, or shortage of time. Mode of delivery, need for neonatal resuscitation, maternal and neonatal vital parameters, drug consumption, and personnel resource expenses were recorded.
  
  
  RESULTS
  Remifentanil target-controlled infusion (TCI) facilitated vaginal delivery in eight out of nine women. No serious adverse events were observed, but three newborns needed initial respiratory support for a few minutes. The total cost of remifentanil TCI administration to facilitate vaginal delivery compared with the estimated additional cost of an emergency caesarean section was negligible.
  
  
  CONCLUSIONS
  This case series suggests that remifentanil TCI may be used to facilitate vaginal delivery in high-risk parturients when other forms of analgesia are limited. However, the small number of patients studied does not allow generalisation of the results; neither can safety concerns be dispelled yet.
authors.affiliation: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. gabs@broadpark.no
authors.forename: G L
authors.initials: GL
authors.lastname: Schwarz
authors.forename: P
authors.initials: P
authors.lastname: Volmanen
authors.forename: S
authors.initials: S
authors.lastname: Albrechtsen
authors.forename: E
authors.initials: E
authors.lastname: Bjoernestad
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000191:economics / Q000379:methods*; D000768:Anesthesia, General; D000773:Anesthesia, Obstetrical; D001778:Blood Coagulation Disorders; D016292:Procedural Sedation / Q000191:economics / Q000379:methods*; D000075202:Contraindications; D036861:Delivery, Obstetric / Q000191:economics / Q000379:methods; D016527:Drug Costs; D005260:Female; D005323:Fetal Monitoring; D017721:Hospital Costs; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007748:Labor Stage, Second; D009294:Narcotics / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D009407:Nerve Block; D010100:Oxygen / Q000097:blood; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D011247:Pregnancy; D011248:Pregnancy Complications; D011250:Pregnancy Complications, Hematologic; D018566:Pregnancy, High-Risk; D000077208:Remifentanil; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics; D010880:Piperidines; D000077208:Remifentanil; D010100:Oxygen