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Maroni A, Aubelle MS, Chollat C. Fetal, Preterm, and Term Neonate Exposure to Remifentanil: A Systematic Review of Efficacy and Safety. Paediatr Drugs 2023; 25:537-555. [PMID: 37541994 DOI: 10.1007/s40272-023-00583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Owing to its pharmacodynamic properties, especially the rapid onset and short duration of its action, the use of remifentanil in obstetric anesthesia, as well as in neonatology, might be increasingly used. OBJECTIVE We conducted a systematic review to assess the efficacy and safety of remifentanil in preterm and term neonates. Outcomes of interest were neonatal adaptation after fetal exposure; neonatal pain, distress, and discomfort control during invasive procedures; and the occurrence of hemodynamic effects or respiratory depression induced by remifentanil infusion. METHODS Given the different contexts of use, we have organized this work into three parts: (A) use of remifentanil for labor or cesarean section, with exposure of the fetus before birth, (B) brief use for neonatal procedural analgesia, and (C) prolonged use for sedation/analgesia of neonates. The bibliographic search was conducted based on keywords using electronic medical databases (DATABASE, Cochrane Library, PubMed, and EMBASE) from 1 January 2000 until 31 December 2022. RESULTS Twenty-two articles were included (10 in part A, 5 in part B and 7 in part C). Prospective, controlled, randomized, blinded, and intention-to-treat trials were retained. Neonates were well adapted after exposure to remifentanil in the fetal period. Pain, stress, and discomfort were controlled during a brief or prolonged invasive procedure when remifentanil was used for sedation/analgesia. The physiological parameters were stable and the procedures were straightforward. Chest wall rigidity appeared to be a common side effect, but this can be managed by slow and continuous infusion and by using the minimum effective dose. CONCLUSIONS Remifentanil appears to be effective and safe in the short term in preterm and full-term neonates. However, its safety is compromised by the risk of chest wall rigidity. It should be used in appropriate neonatal units and in the presence of physicians able to monitor its side effects. Long-term outcomes have not been evaluated, to our knowledge.
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Affiliation(s)
- Arielle Maroni
- Pediatric Intensive Care Unit, Robert Debré University Hospital, APHP, 75019, Paris, France
| | | | - Clément Chollat
- Department of Neonatal Paediatrics, Trousseau Hospital, APHP, Sorbonne Université, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France.
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Wang Y, Chen Z, Dang X, Jiang N, Cui K, Su S. Different Doses of Ropivacaine either with Sufentanil or with Dexmedetomidine for Labor Epidural Anesthesia regarding Painless Childbirth: A Retrospective, Multicenter Study. Pharmacology 2022; 107:386-397. [PMID: 35609521 DOI: 10.1159/000524304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sufentanil is used with ropivacaine in labor pain management but it can have respiratory depression. Dexmedetomidine is effective to maintain hemodynamic stability in parturient women and allow awake intubation. However, dexmedetomidine is suggested only in patients with major cardiovascular disease that mandates stable hemodynamics (Reference ID: 3987541-USFDA). The objective of the study was to compare different doses of ropivacaine either with sufentanil or with dexmedetomidine for epidural anesthesia regarding labor pain management. METHODS Parturient women have received 0.125% ropivacaine with 0.5-μg/mL sufentanil (SR1 cohort, n = 115), or 0.08% ropivacaine with 0.5-μg/mL sufentanil (SR2 cohort, n = 109), or 0.125% ropivacaine with 0.5-μg/mL dexmedetomidine (DR1 cohort, n = 124), or 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine (DR2 cohort, n = 135) for epidural anesthesia during vaginal delivery or cesarean section. RESULTS At 2-h postpartum, the visual analog scale score of parturient women of the DR2 cohort was fewer than that of parturient women of the SR1 (p < 0.0001, q = 4.162) and the SR2 (p < 0.0001, q = 7.568) cohorts and statistically the same as that of parturient women of the DR1 cohort (p < 0.0001, q = 3.087). Bradycardia and itching were reported in parturient women of the DR2 and the DR1 cohorts while nausea, vomiting, and urinary retention at 6 h were reported in parturient women of the SR1 and the SR2 cohorts. In the DR2 cohort, there were fewer numbers of parturient women with bradycardia (4 vs. 19, p < 0.0001, q = 6.613) and hypotension (2% vs. 1%) than those in the DR1 cohort. The child born by women of the DR2 cohort had high partial arterial pressure of oxygen than those born by women of the DR1 (p < 0.0001, q = 18.663), the SR1 (p < 0.0001, q = 29.366), and the SR2 (p < 0.0001, q = 24.039) cohorts. DISCUSSION/CONCLUSION Epidural 0.08% ropivacaine with 0.5-μg/mL dexmedetomidine is an effective and safe anesthetic regimen for hypertensive parturient women and their newborns. LEVEL OF EVIDENCE III. Technical Efficacy Stage: 4.
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Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Zhaowen Chen
- Department of Obstetrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Xiujing Dang
- Department of Anesthesiology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Ning Jiang
- Department of Pediatrics, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Kai Cui
- Department of Urological Surgery, Armed Police Shandong Corps Hospital, Jinan, China
| | - Shiyu Su
- Department of Anesthesiology, The Fifth People's Hospital of Jinan, Jinan, China
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Cheng Q, Bi X, Zhang W, Lu Y, Tian H. Dexmedetomidine versus sufentanil with high- or low-concentration ropivacaine for labor epidural analgesia: A randomized trial. J Obstet Gynaecol Res 2019; 45:2193-2201. [PMID: 31502323 DOI: 10.1111/jog.14104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022]
Abstract
AIM To study analgesic effects of dexmedetomidine or sufentanil, both combined with ropivacaine, in epidural analgesia during labor. METHODS We recruited 160 primigravidae with full-term pregnancy who received epidural anesthesia during labor and randomized them into four groups to receive epidural administration of ropivacaine combined with sufentanil (RS1 and RS2 groups) or with dexmedetomidine (RD1 and RD2 groups). Systolic blood pressure, diastolic blood pressure and heart rate before anesthesia (T1 ), 15 min after anesthesia induction (T2 ), on delivery (T3 ) and 2 h postpartum (T4 ), together with visual analogue scale scores, Bromage scores, Ramsay scores, adverse reactions during analgesia and urinary retention at 6 and 24 h postpartum were recorded; the pH, PCO2 and PO2 of umbilical cord arterial blood and Apgar scores at 1, 5 and 10 min after childbirth were assessed. RESULTS RS1 group had significantly lower systolic blood pressure, diastolic blood pressure and heart rate than RD1 group at T2 and T3 (all P < 0.05), but not at T1. At T2 and T3 , the other three groups were lower than RS2 group in visual analogue scale and Ramsay scores (all P < 0.05). After childbirth, RD2 group had significantly higher PO2 result than other three groups (P < 0.05). At 6 h postpartum, RD2 group had significantly fewer cases of urinary retention than RD1 and RS1 groups (both P < 0.05). CONCLUSION A relatively low concentration of ropivacaine, combined with dexmedetomidine, is better in analgesia during labor.
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Affiliation(s)
- Qiuju Cheng
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Xiaobao Bi
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Weiqiang Zhang
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Yanling Lu
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
| | - Hang Tian
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong Province, China
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Sheyklo SG, Hajebrahimi S, Moosavi A, Pournaghi-Azar F, Azami-Aghdash S, Ghojazadeh M. Effect of Entonox for pain management in labor: A systematic review and meta-analysis of randomized controlled trials. Electron Physician 2018; 9:6002-6009. [PMID: 29560153 PMCID: PMC5843427 DOI: 10.19082/6002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 10/27/2017] [Indexed: 12/16/2022] Open
Abstract
Background and aim Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor. Methods This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used. Results Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was −1.01 (95% CI: −1.59 to −0.43, Q=148.5, df=8, p=0.02, I2=76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I2=85.3) this difference was significant (p<0.05). The results of mothers’ satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate. Conclusion According to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers’ satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran.
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Affiliation(s)
- Sepideh Gareh Sheyklo
- Assistant Professor, Department of Obstetrics and Gynecology, Dezful University of Medical Sciences, Dezful, Iran
| | - Sakineh Hajebrahimi
- Professor, Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Moosavi
- Associate Professor, Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Fatemeh Pournaghi-Azar
- Assistant Professor, Dental and Periodontal Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Associate Professor, Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
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Weibel S, Jelting Y, Afshari A, Pace NL, Eberhart LHJ, Jokinen J, Artmann T, Kranke P. Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour. Cochrane Database Syst Rev 2017; 4:CD011989. [PMID: 28407220 PMCID: PMC6478102 DOI: 10.1002/14651858.cd011989.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Multiple analgesic strategies for pain relief during labour are available. Recently remifentanil, a short-acting opioid, has recently been used as an alternative analgesic due to its unique pharmacological properties. OBJECTIVES To systematically assess the effectiveness of remifentanil intravenous patient-controlled analgesia (PCA) for labour pain, along with any potential harms to the mother and the newborn. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 December 2015), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), handsearched congress abstracts (November 2015), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials comparing remifentanil (PCA) with another opioid (intravenous (IV)/intramuscular (IM)), or with another opioid (PCA), or with epidural analgesia, or with remifentanil (continuous IV), or with remifentanil (PCA, different regimen), or with inhalational analgesia, or with placebo/no treatment in all women in labour including high-risk groups with planned vaginal delivery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data, and appraised study quality.We contacted study authors for additional information other than incomplete outcome data. We performed random-effects meta-analysis.To reduce the risk of random error in meta-analysis we performed trial sequential analysis. We included total zero event trials and used a constant continuity correction of 0.01 (ccc 0.01) for meta-analysis. We applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to assess the quality of evidence. MAIN RESULTS Twenty RCTs with 3569 women were included. Of those, 10 trials (2983 participants) compared remifentanil (PCA) to an epidural, four trials (216 participants) to another opioid (IV/IM), three trials (215 participants) to another opioid (PCA), two trials (135 participants) to remifentanil (continuous IV), and one trial (20 participants) to remifentanil (PCA, different regimen). No trials were identified for the remaining comparisons.Methodological quality of studies was moderate to poor. We assessed risk of bias as high for blinding issues and incomplete outcome data in 65% and 45% of the included studies, respectively.There is evidence of effect that women in the remifentanil (PCA) group were more satisfied with pain relief than women in the other opioids (IV/IM) group (standardised mean difference (SMD) 2.11, 95% confidence interval (CI) 0.72 to 3.49, four trials, very low-quality evidence), and that women were less satisfied compared to women in the epidural group (SMD -0.22, 95% CI -0.40 to -0.04, seven trials, very low-quality evidence).There is evidence of effect that remifentanil (PCA) provided stronger pain relief at one hour than other opioids administered IV/IM (SMD -1.58, 95% CI -2.69 to -0.48, three trials, very low-quality evidence) or via PCA (SMD -0.51, 95% CI -1.01 to -0.00, three trials, very low-quality evidence). Pain intensity was higher in the remifentanil (PCA) group compared to the epidural group (SMD 0.57, 95% CI 0.31 to 0.84, six trials, low-quality evidence).Data were limited on safety aspects for both the women and the newborns. Only one study analysed maternal apnoea in a comparison of remifentanil (PCA) versus epidural and reported that half of the women in the remifentanil and none in the epidural group had an apnoea (very low-quality evidence). There is no evidence of effect that remifentanil (PCA) was associated with an increased risk for maternal respiratory depression when compared to epidural analgesia (RR 0.91, 95% CI 0.51 to 1.62, ccc 0.01, three trials, low-quality evidence) and no reliable conclusion might be reached compared to remifentanil (continuous IV) (all study arms included zero events, two trials, low-quality evidence). In one trial of remifentanil (PCA) versus another opioid (IM) three out of 18 women in the remifentanil and none out of 18 in the control group had a respiratory depression (very low-quality evidence).There is no evidence of effect that remifentanil (PCA) was associated with an increased risk for newborns with Apgar scores less than seven at five minutes compared to epidural analgesia (RR 1.26, 95% CI 0.62 to 2.57, ccc 0.01, five trials, low-quality evidence) and no reliable conclusion might be reached compared to another opioid (IV) and compared to remifentanil (PCA, different regimen) both with zero events in all study arms (one trial, very-low quality evidence). In one trial of remifentanil (PCA) versus another opioid (PCA) none out of nine newborns in the remifentanil and three out of eight in the opioid (PCA) group had Apgar scores less than seven (very-low quality evidence).There is evidence that remifentanil (PCA) was associated with a lower risk for the requirement of additional analgesia when compared to other opioids (IV/IM) (RR 0.57, 95% CI 0.40 to 0.81, three trials, moderate-quality evidence) and that it was associated with a higher risk compared to epidural analgesia (RR 9.27, 95% CI 3.73 to 23.03, ccc 0.01, six trials, moderate-quality evidence). There is no evidence of effect that remifentanil (PCA) reduced the requirement for additional analgesia compared to other opioids (PCA) (RR 0.76, 95% CI 0.45 to 1.28, three trials, low-quality evidence).There is evidence that there was no difference in the risk for caesarean delivery between remifentanil (PCA) and other opioids (IV/IM) (RR 0.63, 95% CI 0.30 to 1.32, ccc 0.01, four trials, low-quality evidence) and epidural analgesia (RR 1.0, 95% CI 0.82 to 1.22, ccc 0.01, nine trials, moderate-quality evidence), respectively. Pooled meta-analysis revealed an increased risk for caesarean section under remifentanil (PCA) compared to other opioids (PCA) (RR 2.78, 95% CI 0.99 to 7.82, two trials, very low-quality evidence). However, a wide range of clinically relevant and non-relevant treatment effects is compatible with this result. AUTHORS' CONCLUSIONS Based on the current systematic review, there is mostly low-quality evidence to inform practice and future research may significantly alter the current situation. The quality of evidence is mainly limited by poor quality of the studies, inconsistency, and imprecision. More research is needed on maternal and neonatal safety outcomes (maternal apnoea and respiratory depression, Apgar score) and on the optimal mode and regimen of remifentanil administration to provide highest efficacy with reasonable adverse effects for mothers and their newborns.
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Affiliation(s)
- Stephanie Weibel
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Yvonne Jelting
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Arash Afshari
- Rigshospitalet, Copenhagen University HospitalJuliane Marie Centre ‐ Anaesthesia and Surgical Clinic Department 4013CopenhagenDenmark
| | - Nathan Leon Pace
- University of UtahDepartment of Anesthesiology3C444 SOM30 North 1900 EastSalt Lake CityUTUSA84132‐2304
| | - Leopold HJ Eberhart
- Philipps‐University MarburgDepartment of Anaesthesiology & Intensive Care MedicineBaldingerstrasse 1MarburgGermany35043
| | - Johanna Jokinen
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
| | - Thorsten Artmann
- Cnopf Children´s Hospital, Hospital HallerwieseDepartment of Anaesthesia and Intensive Care MedicineNuernbergGermany
| | - Peter Kranke
- University of WürzburgDepartment of Anaesthesia and Critical CareOberduerrbacher Str. 6WürzburgGermany
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Attar AS, Feizabadi AS, Jarahi L, Feizabadi LS, Sheybani S. Effect of Entonox on reducing the need for Pethidine and the Relevant Fetal and Maternal Complications for Painless Labor. Electron Physician 2016; 8:3325-3332. [PMID: 28163844 PMCID: PMC5279962 DOI: 10.19082/3325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 10/25/2016] [Indexed: 01/18/2023] Open
Abstract
Background Pain relief during labour is one of the major concerns in obstetrics; severe labor pain causes fear of the next pregnancy, and interferes with the mother’s family relationship. Objective The aim of this study was to evaluate the analgesic effects of Entonox during labor on reducing the need for pethidine (Meperidine) and fetal-maternal complications. Methods This double-blind randomized clinical trial was conducted on pregnant women who were candidates for vaginal delivery in Educational Hospitals of Mashhad University of Medical Sciences, Iran between January 2014 and November 2015. After entering into the inactive phase of labor, participants were randomly allocated to receive inhaled Entonox gas (n=200) or inhale Oxygen (n=200) as a control group. Mothers inhaled the gas at commencement of pain, and ceased as soon as the pain diminished, up to the end of the second stage of labor which was the neonate’s birth. Main outcomes were pain score based on NRS (numerical rating scale), duration of delivery, required pethidine, maternal complications and satisfaction during labour. Chi-square and Independent T-test were used via SPSS for data analysis and P-value less than 0.05 was considered statistically significant. Results Four-hundred pregnant women with a mean age of 26.4±5.9 years were studied. Complications such as nausea, vomiting, dizziness, and drowsiness were reported in 25% of the Entonox group and 23% in the control group (p=0.640). Mean of pain severity score during labor in the Entonox and control groups was 4.5±1.2 and 5.2±1.4, respectively (p<0.001). Pethidine requirement, significantly was lower in the Entonox group (31.6±11.8 versus 35.7±12.4; p<0.001). Conclusion In our study, Entonox significantly reduced pain during delivery without significant increase in maternal and neonatal complications. Trial registration The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2015102713159N6. Funding This research has been financially supported by Research Council of Mashhad University of Medical Sciences.
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Affiliation(s)
- Alireza Sharifian Attar
- M.D., Associate Professor, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefe Shirinzadeh Feizabadi
- M.D., Resident of Anesthesiology, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Iran
| | - Lida Jarahi
- M.D., Associate Professor of Community Medicine, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Laya Shirinzadeh Feizabadi
- M.D., Fellowship of Gynecologic Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Sheybani
- M.D., Fellowship of Anesthesia in Cardiac Surgery, Assistant Professor of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Najafi TF, Bahri N, Ebrahimipour H, Najar AV, Taleghani YM. Risk Assessment of Using Entonox for the Relief of Labor Pain: A Healthcare Failure Modes and Effects Analysis Approach. Electron Physician 2016; 8:2150-9. [PMID: 27123224 PMCID: PMC4844482 DOI: 10.19082/2150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/26/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In order to prevent medical errors, it is important to know why they occur and to identify their causes. Healthcare failure modes and effects analysis (HFMEA) is a type of qualitative descriptive that is used to evaluate the risk. The aim of this study was to assess the risks of using Entonox for labor pain by HFMEA. METHODS A mixed-methods design (qualitative action research and quantitative cross-sectional research) was used. The modes and effects of failures in the process of using Entonox were detected and analyzed during 2013-2014 at Hefdahe Shahrivar Hospital, Mashhad, Iran. Overall, 52 failure modes were identified, with 25 being recognized as high-risk modes. RESULTS The results revealed that 48.5% of these errors fall into the care process type, 22.05% belong to the communicative type, 19.1% fall into the administrative type, and 10.2% are of the knowledge and skills type. Strategies were presented in the forms of acceptance (3.2%), control (90.3%), and elimination (6.4%). CONCLUSION The following actions are suggested for improving the process of using Entonox: Close supervision by the midwife, precise recording of all the stages of the process in the woman's medical record, the necessity of the presence of the anesthesiologist at the woman's bedside during labor, confirming the indications for use of Entonox, and close monitoring to ensure the safety of the gas cylinder guards.
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Affiliation(s)
- Tahereh Fathi Najafi
- Ph.D. Student of Reproductive and Sexual Health, Department of Midwifery, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Narjes Bahri
- Ph.D. Student of Reproductive Health, Department of Midwifery, faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Hosein Ebrahimipour
- Ph.D. of Health services Management, Associate Professor, Health Sciences Research Center, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Vafaee Najar
- Ph.D. of Health Services Management, Associate Professor, Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasamin Molavi Taleghani
- Ph.D. Student of Health Services Administration, Health Management and Economics Research Center, Department of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
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Van de Velde M, Carvalho B. Remifentanil for labor analgesia: an evidence-based narrative review. Int J Obstet Anesth 2016; 25:66-74. [DOI: 10.1016/j.ijoa.2015.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/25/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022]
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Agah J, Baghani R, Tabaraei Y, Rad A. Maternal Side-Effects of Continuous vs. Intermittent Method of EntonoxDuring Labor: A Randomized Clinical Trial. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2016; 15:641-6. [PMID: 27642337 PMCID: PMC5018294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Labor pain is one of the most tiresome types of pain. So human has been seeking to allay this pain until now. Administration of a suitable agent such as Entonox during labor is very beneficial for childbirth outcomes. Entonox can be administered in two ways: intermittently and continuously. The aim of this study is to demonstrate whether continuous method is as safe as intermittent method? This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. One hundred admitted women for vaginal delivery were included in this study. Fitted patients were randomly divided into two equal groups. After thorough training, the patients used Entonox during active phase of labor. Fifty parturients used it intermittently and 50 others used it continuously. Then, maternal adverse effects, satisfaction and labor progression were registered and compared in two groups. Statistical Analysis was performed by spss17 software, t-test and chi square test. The maternal side effects of Entonox had no significant difference in two groups (p>0.05). Mothers' satisfaction rate in continuous group was more than the intermittent group significantly (p<0.001). Meantime of active phase of labor had no significant difference between two groups (p=0.2). It seems that by more investigations, there will be conditions for mothers to choose the desired method of Entonox usage, intermittently or continuously. This approach leads to reduction of difficult labor and cesarean section and consequently helps improvement of maternal health level, both physically and psychologically.
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Affiliation(s)
- Jila Agah
- Department of Obstetrics and Gynecology, Mobini hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran.,
| | - Roya Baghani
- Department of Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Yaser Tabaraei
- Department of Biostatistics, Faculty of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Abolfazl Rad
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
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