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 View selected GUIDELINE examples Dated
Kingston Hospital May 2013
Dudley Hospital May 2013
Lancashire Teaching Hospital NHS Trust May 2013
Ulster Community & Hospitals Trust
   - Remifentanil PCA for Labour Guideline
   - Information sheet for women

University Hospital Southampton

  - Labour Guideline

  - Patient Information

May 2013


  (These guidelines first displayed in January 2010)



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General points
  • Remifentanil being used more widely in some units and in others really just when epidural contraindicated ( Kingston, Dudley)
  • Different concentrations of remifentanil used in different hospitals –( Dudley base on weight.)
  • Not to be given within 4 hours of other parenteral opiates
  • 2 minute lockout time used
  • Not for use in preterm mothers
  • Oxygen delivery routine
  • Most hospitals included a patient information leaflet and observation chart
  • All emphasise the importance of continuously monitoring SaO2 in patients on remifentanil PCA.
  • Recognition that analgesia may be improved but not complete and the additional need for TENS / Entonox
  • Need for one to one midwifery care and  constant presence of midwife( Southampton)
We liked
  • Description of Remifentanil and details of preparation for PCA
  •  Reminder of the dangers of Remifentanil and unlicensed drug
  • Explicit mention of dedicated , labelled cannula and not to flush
  • Specifics of how to prevent desaturation and measures necessary if desaturation does occur
  • Clear layout of guidelines
  • Information sheet for mothers
  • Comparison with epidurals (Southampton, Kingston)
  • Reminder to continue monitoring for half an hour after discontinue
We didn’t like
  • If a weight based regime is used for bolus administration, should caution the user to use lean body mass in obese patients for dose calculation
We’re not sure
  • Information re benefits of Remifentanil – ? can say that Remi results in reduced risk of section and emerg section ( Kingston) and also say that less risk of low SA02 than Pethidine
  • Stopping Remifentanil when start pushing
Other points
  • The more midwifery staff are using Remifentanil, the better in terms of their experience. If only using it once or twice per year may not be confident in use and aware of how to deal wih complications