Anyone use remifentanil infusions for labor analgesia?

[acidbase1]

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So had a G1P0 patient with platelet count of 40k. No neuraxial obviously. No NICU here so couldn’t run fentanyl or dilaudid PCA. Do you run a basic infusion? Is much transferred across placenta? Is there ever depression of the neonate and do they metabolize it as quickly as adults? And finally, can you safely run this in L&D without a NICU?

Thanks in advance

 

[Hoya11]

Yes. Works great and is underused. We did PCA boluses and a basal rate. I would have to look up the exact dosing..

 

[deleted697535]

Needs lot of nursing support on board. We have a protocol and it works well. Billing is an issue tho

 

[Daveizzy]

We just started, no basal, 1:1 nursing

 

[narcusprince]

We have a protocol. Needs a good well thought system in place. From pharmacy to nursing support and recognizing early on she is a candidate for remi.

 

[NightNight]

Bears repeating, nursing has to be on board.
Pharmacy is always the biggest headache.

0.05-0.1mcg/kg/min (IBW) basal
20-25mcg Q2min demand

Timing boluses is key, so you need to coach the patient and sit with them through a few contractions til they get the hang of it (no more time than I would spend for an epidural).

 

[vector2]

I've run it a handful of times and never seen respiratory depression in the baby. Usually 50-100mcg bolus up front depending on current pain and 25mcg q3 min demand. Will typically need some reassessment during labor cause I've seen some wildly varying pain tolerances, but it's a gazillion times better than nitrous once you have the right demand dialed in.

 

[The Physician Philosopher]

Just have to be really careful. Being off a decimal point with remi while setting up that infusion could lead to some serious morbidity. That said, if the system in place is solid with multiple safety mechanisms... might be able to work well.

The context sensitive half life is so short with remi that even if some small portion of it came across to the fetus, it would go away quick.

 

[MirrorTodd]

Just have to be really careful. Being off a decimal point with remi while setting up that infusion could lead to some serious morbidity. That said, if the system in place is solid with multiple safety mechanisms... might be able to work well.

The context sensitive half life is so short with remi that even if some small portion of it came across to the fetus, it would go away quick.

Don't newborns have decreased esterase activity though? Or is it just decreased enough to matter?