Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands

S. L.M. Logtenberg, M. L. Vink, M. B. Godfried, I. C.M. Beenakkers, F. G. Schellevis, B. W. Mol, C. J. Verhoeven

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

© 2018 Elsevier Ltd Background: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial 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 during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. Methods: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. 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 independently by two expert teams. Results: We received information from all hospitals. After independent assessments, 17 cases of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac arrest; and two neonatal cases of respiratory depression, over a period of more than 10 years of remifentanil patient-controlled analgesia use, were identified as a serious adverse event. All serious adverse events were resolved without irreversible damage. Conclusions: The risk of a potentially life-threatening serious adverse event attributed to remifentanil patient-controlled analgesia seems to be low. All patients recovered without deficit. Adherence to strict monitoring and the attendance of trained healthcare providers is required to safely use remifentanil for labour analgesia.
Original languageEnglish
Pages (from-to)22-28
JournalInternational Journal of Obstetric Anesthesia
Volume39
Early online date2018
DOIs
Publication statusPublished - Aug 2019

Cite this

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title = "Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands",
abstract = "{\circledC} 2018 Elsevier Ltd Background: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial 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 during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. Methods: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. 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 independently by two expert teams. Results: We received information from all hospitals. After independent assessments, 17 cases of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac arrest; and two neonatal cases of respiratory depression, over a period of more than 10 years of remifentanil patient-controlled analgesia use, were identified as a serious adverse event. All serious adverse events were resolved without irreversible damage. Conclusions: The risk of a potentially life-threatening serious adverse event attributed to remifentanil patient-controlled analgesia seems to be low. All patients recovered without deficit. Adherence to strict monitoring and the attendance of trained healthcare providers is required to safely use remifentanil for labour analgesia.",
keywords = "Apnoea, Bradycardia, Cardiac arrest, Oxygen saturation, Remifentanil patient-controlled analgesia, Respiratory depression, Serious adverse event",
author = "Logtenberg, {S. L.M.} and Vink, {M. L.} and Godfried, {M. B.} and Beenakkers, {I. C.M.} and Schellevis, {F. G.} and Mol, {B. W.} and Verhoeven, {C. J.}",
year = "2019",
month = "8",
doi = "10.1016/j.ijoa.2018.10.013",
language = "English",
volume = "39",
pages = "22--28",
journal = "International Journal of Obstetric Anesthesia",
issn = "0959-289X",
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Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands. / Logtenberg, S. L.M.; Vink, M. L.; Godfried, M. B.; Beenakkers, I. C.M.; Schellevis, F. G.; Mol, B. W.; Verhoeven, C. J.

In: International Journal of Obstetric Anesthesia, Vol. 39, 08.2019, p. 22-28.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands

AU - Logtenberg, S. L.M.

AU - Vink, M. L.

AU - Godfried, M. B.

AU - Beenakkers, I. C.M.

AU - Schellevis, F. G.

AU - Mol, B. W.

AU - Verhoeven, C. J.

PY - 2019/8

Y1 - 2019/8

N2 - © 2018 Elsevier Ltd Background: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial 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 during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. Methods: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. 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 independently by two expert teams. Results: We received information from all hospitals. After independent assessments, 17 cases of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac arrest; and two neonatal cases of respiratory depression, over a period of more than 10 years of remifentanil patient-controlled analgesia use, were identified as a serious adverse event. All serious adverse events were resolved without irreversible damage. Conclusions: The risk of a potentially life-threatening serious adverse event attributed to remifentanil patient-controlled analgesia seems to be low. All patients recovered without deficit. Adherence to strict monitoring and the attendance of trained healthcare providers is required to safely use remifentanil for labour analgesia.

AB - © 2018 Elsevier Ltd Background: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial 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 during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. Methods: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. 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 independently by two expert teams. Results: We received information from all hospitals. After independent assessments, 17 cases of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac arrest; and two neonatal cases of respiratory depression, over a period of more than 10 years of remifentanil patient-controlled analgesia use, were identified as a serious adverse event. All serious adverse events were resolved without irreversible damage. Conclusions: The risk of a potentially life-threatening serious adverse event attributed to remifentanil patient-controlled analgesia seems to be low. All patients recovered without deficit. Adherence to strict monitoring and the attendance of trained healthcare providers is required to safely use remifentanil for labour analgesia.

KW - Apnoea

KW - Bradycardia

KW - Cardiac arrest

KW - Oxygen saturation

KW - Remifentanil patient-controlled analgesia

KW - Respiratory depression

KW - Serious adverse event

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U2 - 10.1016/j.ijoa.2018.10.013

DO - 10.1016/j.ijoa.2018.10.013

M3 - Article

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JF - International Journal of Obstetric Anesthesia

SN - 0959-289X

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