Engelen S, Derks J, Beenakkers I
Acta Anaesthesiol Belg. 2016;67(4):151-155.
Remifentanil patient controlled intravenous analgesia (PCIA) during labor has rapidly gained popularity. Its pharmacological profile makes it suitable for this indication. However, remifentanil is a potent respiratory depressant that might cause serious maternal hypoventilation, respiratory arrest and desaturation.
In the present study we compared standard monitoring of parturients (saturation measurements and visual respiratory rate measurements at set times) with continuous monitoring. Data of patients in the standard monitoring group were collected from handwritten charts containing oxygen saturation and respiratory rate. The patients in the continuous monitoring group were connected to a device that measures the oxygen saturation and respiratory rate every two seconds and automatically saves the data. These data were analyzed retrospectively.
In the standard monitoring group 1 patient (1%) had severe desaturation SpO₂ < 80%, 22 patients (25%) had SpO₂ < 94% and in no patient a respiratory rate (RR) < 8/min was recorded. In the continuous monitoring group 20 patients (33%) showed SpO₂ < 80%, 58 patients (97%) SpO₂ < 94% and 38 patients (63%) had bradypnea (RR < 8/min). The analysis of the data of the continuous monitoring group showed severe desaturations and serious respiratory depression.
The standard intermittent monitoring strategy dramatically underestimated the incidence of both bradypnea and oxygen desaturations with undetected hypoxemia and possible complications as a consequence. During use of remifentanil PCIA one-to-one midwifery care is advised. When obstetric caregivers are not present in the immediate vicinity of the parturient, high quality continuous monitoring, remote alarm notification and readiness for immediate corrective intervention are essential for safe use of this analgesic strategy.
瑞芬太尼患者自控静脉镇痛（PCIA）在分娩期间迅速普及。其药理学特性使其适用于该适应症。然而，瑞芬太尼是一种强效呼吸抑制剂，可能导致严重的产妇通气不足、呼吸骤停和血氧饱和度降低。
在本研究中，我们将产妇的标准监测（在设定时间进行饱和度测量和视觉呼吸频率测量）与连续监测进行了比较。标准监测组患者的数据来自包含血氧饱和度和呼吸频率的手写图表。连续监测组的患者连接到一台每两秒测量一次血氧饱和度和呼吸频率并自动保存数据的设备。这些数据进行了回顾性分析。
在标准监测组中，1名患者（1%）出现严重血氧饱和度降低（SpO₂<80%），22名患者（25%）SpO₂<94%，且未记录到任何患者呼吸频率（RR）<8次/分钟。在连续监测组中，20名患者（33%）SpO₂<80%，58名患者（97%）SpO₂<94%，38名患者（63%）出现呼吸过缓（RR<8次/分钟）。对连续监测组数据的分析显示存在严重的血氧饱和度降低和严重的呼吸抑制。
标准的间歇性监测策略极大地低估了呼吸过缓和血氧饱和度降低的发生率，从而导致未被检测到的低氧血症及可能的并发症。在使用瑞芬太尼PCIA期间，建议提供一对一的助产护理。当产科护理人员不在产妇附近时，高质量的连续监测、远程警报通知以及立即进行纠正干预的准备对于安全使用这种镇痛策略至关重要。
