Intravenous remifentanil analgaesia for an obstetric patient with type I neurofibromatosis and a factor V Leiden mutation

Type i neurofibromatosis is characterised by altered skin pigmentation and the growth of benign tumours,particularly along the peripheral nerves and central nervous system. we report a 36-year-old primigravida woman in labour who was admitted to the obstetric suite of the hospital sant joan de déu,barcelona,spain,in 2007 with hypothyroidism,type i neurofibromatosis and a factor v leiden mutation. due to a lack of cranial and spinal imaging data,an epidural was not indicated; instead,continuous intravenous remifentanil analgaesia was administered. the remifentanil infusion was self-titrated by the patient using a visual analogue scale,with the dosage ranging from 0.01 to 0.25 μg/kg/minute. due to rotational dystocia,kjelland-type forceps were used during the delivery. after birth,the infant was found to have apgar scores of 9 and 10,with no maternal or neonatal adverse effects observed. although still controversial,remifentanil may be a successful alternative for analgaesia in similar cases; however,the specific risks and benefits for each patient should be considered prior to administration. © 2017,sultan qaboos university. all rights reserved.