Remifentanil perfusor during labor,瑞芬太尼在分娩镇痛中的应用Use of Remifentanil Perfusor during Labor in the Rijnland Hospital, Leiderdorp, Netherlands,www.themegallery.com,Labor analgesia is the development needs of 21st century medicine,CSEA+PCEAambulatory or walking EA Remifentanil PCIALA,19th Century,20th Century,20th Century,21th Century,1938 Graffagnino， Seyler：EBLA（USA） 1940 Benthin :Pethidine IV LA（FRG）1984 CSEALSCS 1988 Lysak，Gambling：PCEALA (AWHONN) 1992 ACOG：Ideal labor analgesia,1933 Grantly Dick Read ：Natural delivery（UK） 1953 Velvovski ：Spirit of preventive LA（SU） 1970 Ferdinand Lamaze （France） 1970 M.Klaus ：Doula 1996 WHO：Care for the mothers birth action TENS, HANS, Acupuncture,1846.10.6，Morton, ether Anesthesia 1847 Simpson JY. Chlorform, LA 1853 Clark J. Chlorform, LA (QueenVictoria ) 1880 N2O（Entonox 1961）, LA,158-year history of labor analgesia,www.themegallery.com,Ideally labor analgesiashould have the following characteristics,www.themegallery.com,Contents,www.themegallery.com,Patient information in the out-patient clinic,Information given to the patient and her husbandAs with every technique, instruction regarding the most efficient use of the Remifentanil infusion / PCA pump contibutes towards a more pleasant labor and delivery.,www.themegallery.com,Patient information in the out-patient clinic,intramuscular Pethidine (Demerol),epidural analgesia,Remifentanil infusion / PCA,Patients who plan on delivering,www.themegallery.com,Information given to the patient and her husband,Powerful，short-acting painkiller Safe and strictly controlled no adverse effects on the child,CBI : a constant level of analgesia feel somewhat sleepy of dizzy,Administer bolus by pressing a button regain control over body again giving extra confidence : difficult time,Points for emphasis,www.themegallery.com,Information given to the patient and her husband,Administer immediately after a contraction bolus is administered over 60 s from arm-to brain is about 20 s equilibration half-life is about 60 s,Stop PCA when her starts to give birth Give the baby time to eliminate remifentanil preventing any possible adverse effects: RD,After at most 30 min New mother feel normal within minutes baby are active and behave normally This is different to the effects of Pethidine,Points for emphasis,www.themegallery.com,Contents,www.themegallery.com,Remifentanil solution,Mix 2 mg Remifentanil in 50 ml NaCl 0.9% in a 50 ml syringe.This results in a 40g/ml Remifentanil solution,Use only 2 mg ampoules of Remifentanil. Have no other size ampoules available. This ensures no mistakes are made making the solution.,Remifentanil solution,www.themegallery.com,Application and dosage of Remifentanil infusion / PCA,Introduce a drip canula, drip system, three-way valve, and one-way valves as shown later. Use a drip pump to administer fluids at a constant rate of 2000-2500 ml/24 hrs. Connect the line from the Remifentanil infusion / PCA pump with a 40 g/ml Remifentanil solution to a three-way valve as shown later.,www.themegallery.com,Application and dosage of Remifentanil infusion / PCA,There are three basic infusion rates: Remifentanil starting rate for women with body weight 90 kg is 100 g/hr (2,5 ml/hr), the Remifentanil infusion rate can be increased in all women to a maximum of 120 g/hr (3 ml/hr) if indicated.,www.themegallery.com,Application and dosage of Remifentanil infusion / PCA,The PCA bolus dose is 30 g (0.75ml), administered over 1 minute, and a lock-out time of 5 minutes. This is the maximum bolus dose, and also the maximum bolus dosage speed. The maximum total dose of Remifentanil per 4 hours = 2,000 g/4 hr = 2 mg/4 hr. Stop the Remifentanil infusion / PCA as birth begins to minimise the chance of neonatal respiratory depression.,www.themegallery.com,Monitoring,www.themegallery.com,What apparatus is needed?,What apparatus is needed?,www.themegallery.com,www.themegallery.com,Setup of the drip system, one-way and three-way valves,Every patient receiving Remifentanil infusion / PCA must have a patent drip system running at a constant rate 2000 2500 ml/24 hrs. The drip system is prepared and attached in the usual manner. The drip system must be attached to the drip canula with one or two three-way valves and a one-way valve in the positions shown on the photographs as setup-1 and setup-2.,www.themegallery.com,Setup of the drip system, one-way and three-way valves,It is absolutely ESSENTIAL that the one-way valve, as well as the three-way valves be positioned as shown. This positioning prevents the Remifentanil backing up in the drip system tubing during periods of raised venous ressure as occur during contractions or other ovements, so preventing a sudden Remifentanil bolus when the contraction passes and the drip starts running again, as well as ensuring a constant infusion of Remifentanil.,www.themegallery.com,tube to drip bag,one-way valve,tube to syringe pump with Oxytocin solution or other drug,