Chapter 15 - Remifentanil infusions and patient-controlled analgesia

Summary

Remifentanil's safety profile in neonates combined with rapid onset and offset means that it offers potential not only as a labor analgesic, when administered as patient-controlled analgesia (PCA), but also as an adjunct to general anesthesia, particularly in high-risk obstetric patients. An ideal intravenous opiate should have an onset and offset that can match the time course of uterine contractions, while preserving uterine contractility and a reassuring cardiotocograph (CTG). The analgesia experienced should be considered worthwhile and there should be minimal maternal and neonatal effects, allowing administration up to and during delivery. Remifentanil can offer sedation and analgesia for the anxious patient without the risk of persistent opioid effects. Systemic opioids are the mainstay of managing discomfort during epidural anesthesia for cesarean section. High doses of remifentanil with general anesthesia have unpredictable neonatal effects, making attendance by a physician trained in neonatal resuscitation mandatory.