PCA pump settings

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  • PCA pump settings
As the woman in labour had chosen remifentanil, she was informed about the use of this type of analgesia and she signed the informed consent. The character and the intensity of pain have been determined and the woman in labour´s blood pressure, breath frequency and saturation have been measured. How will the remifentanil solution be diluted and how will the PCA pump be set?

Ultiva or Remifentanil B. Braun (1 mg) is diluted in 50 mL of normal saline for the final concentration 20 µg/mL in every bolus administered in 3 minutes lock-out interval.

Correct answer

The 20 µg/mL concentration has been confirmed by some studies to be the appropriate one for the start of administration. It is possible either to increase the dosing if the pain is not reduced properly or to decrease the dosing if side effects appear. The 3 minutes lock-out interval is appropriate as it is the same as the context-sensitive half-time of remifentanil.


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Ultiva or Remifentanil B. Braun (2 mg) is diluted in 50 mL of normal saline for the final concentration 40 µg/mL in every bolus administered in 3 minutes lock-out interval and with the fixed basal application of 0.2 µg/kg/h.

Wrong answer

Both the bolus and the fixed basal application are too high, as these concentrations increase the risk of side effects. Moreover, the fixed amount of both the bolus and the fixed basal doses do not respond to the intermitent character of labor pain with increasing intensity and frequency.


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Ultiva or Remifentanil B. Braun (1 mg) is diluted in 50 mL of normal saline for the final concentration 20 µg/mL in every bolus administered in 1 minute lock-out interval.

Wrong answer

The 20 µg/mL concentration has been confirmed by some studies to be the appropriate one for the start of the administration. But the 1 minute lock-out interval increases the risk of remifentanil accumulation in the body and the subsequent side effects, such as the respiratory depression.


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PCA (patient-controlled analgesia) - a device allowing a patient to set the administration of analgetics by subjective pain feelings. The maximal dose of analgetics cannot be exceeded, because it is set by a healthcare worker.×
 
RR

16 bpm

HR

74 bpm

SpO2

99 %

BP

94/62 mmHg

ECG

not available

 

Gly

not available

ABG

not available

CBC

not available

biochemical analysis

not available