Remifentanil

[PurplePidjin]

en.wikipedia.org/wiki/Remifentanil

At antenatal last night we were told about this "new" drug that is being used in childbirth at the hospital I'm going to, kind of at that awkward stage between gas and air and epidural. Apparently mums that have had it think it's wonderful and, because it breaks down so fast, there are none of the issues associated with pethidine.

Has anyone had it? And could a scientific-type clever person please explain the up and down sides to me in words of one syllable or less?! I'm aware that wikipedia is not always a fully trustworthy source

It's an opioid and acts on the same receptor (located in the brain, spinal cord and some peripheral sites) as morphine and pethidine but the half life (time that the plasma concentration takes to fall to half the original level) is much shorter so it's often given by intravenous infusion. One the infusion has been turned off the effect wears off very quickly.

Thanks :) from what I've read (of which i understand maybe 1/3!) it's administered by a button on demand, so you take a hit as the contraction gains momentum and it wears off in between?

I'm wary of pethidine because of the effects on the baby, but don't want to go straight from g+a to epidural if i can help it. Seriously tempted to try this as an alternative...

We learnt about this at my ante-natal classes too, although it's so new at my hospital the midwives had to revise before the class as they knew very little about it!

I did quite a bit of google research when I got back and the feedback was not good. It seems to really knock people out so you're as stuck on your back in the bed as you would be with an epidural but without being "with it". And because it needs an anaesthetist to set up (Im not sure why this is or if that is specific to my hospital) you're pretty much stuck with it or nowt as they are unlikely to come straight back and set up an epidural for you when they've just been to see you & set this up.

My birth plan is pretty open-minded but this is the one thing I've said I definitely don't want. Admittedly the injectable opiate at my hospital is diamorphine rather than pethidine which anecdotally is less respiratory-depressive in newborns, so I'd be happier about that.

I had this and 2 years ago and I thought it was brilliant, tried gas and air and made me extremely sick so was offered this instead. As soon as you feel a contraction you press the button and get almost instant pain relief and wears off very quickly. I did feel quite tired once I had pressed it but it wore off really quickly. The only downsides I had to have oxygen as my levels kept dipping not sure if this is due to the drip or not and I wish the midwife had told me to not press once in the pushing stage as it slowed me down as I wasn't putting full effort into my pushes. My mil saw this and swiftly took the button away from me and DD was born very quickly afterwards.