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A survey of intravenous remifentanil use for labor analgesia at academic medical centers in the United States
Abstract Number: T-24
Abstract Type: Original Research
Intravenous (IV) remifentanil is one of few moderately effective alternatives to neuraxial labor analgesia, most commonly offered in the US to women for whom neuraxial analgesia is contraindicated. There remains a lack of consensus regarding the optimal mode of administration (bolus versus continuous or combination of both), dosing strategy, as well as requirements for maternal monitoring when remifentanil is used. We designed this survey to evaluate current practices at academic medical centers in the US that are using remifentanil for labor analgesia.
A list of all academic medical centers with anesthesiology residency programs was established (N=126) and a survey link (SurveyMonkey) made available online from May 28, 2015 - July 13, 2015. The survey consisted of 16 questions sent by email to the obstetric anesthesia directors of these programs.
The response rate was 67% (84/126); 30/84 (36%) reported that remifentanil is used at their center. There were differences in administration (PCA only, PCA & infusion, infusion only), as well as maternal monitoring across centers (Table 1). No center used remifentanil more than 20 times in the prior year. Based on the responses, one can estimate that there were no more than 340 women receiving remifentanil during labor across the 84 centers in the last 12 months (<5 cases in 15 centers, 5-10 cases in 11 centers, 10-20 cases in 4 centers; Table 1). There were 9 cases of maternal respiratory complications reported in 7 centers (one of which occurred after the pharmacy prepared a 100-fold more concentrated solution), and 5 cases of neonatal respiratory complications. All cases of neonatal complications were reported at centers where maternal complications occurred, and 4/5 occurred in centers using remifentanil < 5 times in the previous year. There were no complications at the 4 centers that used remifentanil 10 – 20 times in the last year.
Only 36% of academic centers in the US use IV remifentanil for labor analgesia, most of which use it less than 5 times yearly. Reported complications were rare; however, 9 cases of maternal and 5 cases of neonatal respiratory depression were reported. Perhaps significantly, these complications occurred in centers where remifentanil is used infrequently. If centers intend to use remifentanil for labor analgesia, clinical protocols and adequate monitoring seem crucial to ensure maternal and neonatal safety.