Remifentanil has been proposed as the most suitable systemic opioid for use in obstetrics. Although the onset and offset are rapid, it cannot achieve maximum effect within the time period of a single uterine contraction. Nevertheless, it provides worthwhile analgesia mainly for the first stage of labor with consistently high maternal satisfaction. Maternal oxygen desaturation limits the dose and suitable monitoring during use is advised. As an adjunct to general anesthesia, it is successful in blunting responses to airway manipulation and providing hemodynamic stability in high-risk women. Neonatal effects when used in labor are minimal, but when combined with general anesthesia neonatal depression is unpredictable and more likely with an infusion dose greater than 0.1 μg/kg/min. © 2008 Elsevier Inc. All rights reserved.
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