Remifentanil epidural

Comparison of parturient - controlled remifentanil with

Abstract Introduction: Epidural analgesia (EA) has significant contraindications including coagulation disorders and parturient refusal. One alternative is intravenous self-administered analgesia using the ultra short-acting opioid remifentanil (rPCA) Remifentanil has an attractive pharmacological profile for use in obstetric analgesia as a technique for mass application, with similar benefits and satisfaction as epidural analgesia The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor. Evron S(1), Ezri T, Protianov M, Muzikant G, Sadan O, Herman A, Szmuk P. Author information: (1)Department of Anesthesia, Obstetric Anesthesia Unit, Edith Wolfson Medical Center, Holon, Israel infection, meningitis, epidural blood clot, severe nerve injury/paralysis (occur in less than one in 50,000 women)Remifentanil will pass across the placenta to your unborn baby and can cause your baby to be drowsy at birth. For this reason, we may advise you to limit the number of times you self-administer remifentanil when your baby's birth is fast-approaching Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia

Remifentanil is an ultrashort-acting synthetic opioid. It has a rapid onset of effect of approximately 1 min. It is uniquely degraded by non-specific tissue and plasma esterases, and does not accumulate, with a context-sensitive half-time of approximately 3 min Conclusion: The results of this study suggests that intravenous remifentanil infusion is a satisfactory alternative to thoracic epidural analgesia. It also avoids the risks associated with epidurals, particularly, in patients requiring heparinization and cardiopulmonary bypass. © 1998 International Anesthesia Research Societ

Intravenous remifentanil vs. epidural levobupivacaine with fentanyl for pain relief in early labour: a randomised, controlled, double-blinded study Acta Anaesthesiol Scand , 52 ( 2008 ) , pp. 249 - 25 Intravenous remifentanil has now been used in a parturient in great pain to provide transient analgesia and sedation to allow placement of an epidural. Although the spinal pharmacology of remifentanil is being investigated, [30,31] there is no preparation of remifentanil currently available that can be administered intraspinally

Remifentanil vs. epidural analgesia for the management of ..

Background: The μ-opioid agonist remifentanil has a rapid onset and offset and a short half-life making it an attractive option for intravenous patient-controlled labour analgesia. We aimed to compare the efficacy of intravenous remifentanil patient-controlled analgesia with epidural ropivacaine/sufentanil during labour Remifentanil is a potent, short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic. Remifentanil is used for sedation as well as combined with other medications for use in general anesthesia Remifentanil is a potent short-acting μ-opioid receptor agonist which is rapidly metabolised in the mother and fetus and may be ideal for labour analgesia

Ultiva™ contains the potent short-acting μ-opioid receptor agonist remifentanil hydrochloride, and it is commonly administered intravenously during general anesthesia. It is not approved for epidural or intrathecal use in clinical practice because it contains glycine as an acidic buffer. However, at this moment, very limited information is available on epidural administration of Ultiva™ BACKGROUND: The aim of this study was to investigate the effect of general anaesthesia combined with remifentanil or epidural blockade on glucose metabolism during surgery. METHODS: We randomly assigned patients undergoing elective colorectal surgery to receive either desflurane anaesthesia supplemented with intravenous remifentanil (n = 7) or. Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta.

The effects of remifentanil or acetaminophen with epidural

  1. Although epidural analgesia during labour is the preferred method because it provides superior analgesia to systemic opioids, various studies show comparable maternal satisfaction with patient controlled remifentanil. 5 6 Two previous studies that assessed satisfaction with pain relief with patient controlled remifentanil compared with epidural analgesia reported no differences
  2. Half as many women in labour who were given a drug called remifentanil to help manage their pain needed a subsequent epidural, compared to the women given pethidine -- the current standard of care,..
  3. Since patient controlled remifentanil is not equivalent to epidural analgesia with respect to AUC for satisfaction with pain relief we recommend epidural analgesia as the method of choice. However, if appropriately counselled on effect and side effects there is, from an economic perspective, no reason to deny women patient controlled remifentanil
  4. imal side effects
  5. These include epidural analgesia, by injection of anaesthetic medication around the nerve roots in the spine, intramuscular or continuous intravenous opioids, and inhalational analgesia such as with nitrous oxide. Remifentanil is a relatively recently introduced potent, short-acting opioid, which gives control over pain relief
  6. utes compared to standard epidural analgesia. Remifentanil has a suitable pharmacological profile for labour analgesia
  7. , bolus infusion speed 2 ml

The women could request an epidural at any time, and other pain relief was stopped if an epidural was given. In the remifentanil group 93% (186/201) of women received the drug, and in the. Remifentanil may be an ideal drug for labor analgesia due to its pharmacodynamic and pharmacokinetic profile. As compared to epidural analgesia, it demonstrated satisfactory for pain relief at the beginning of labour with a gradual elevation of pain scores as labour progresses

Introduction The ultra-short acting synthetic opioid remifentanil has recently been introduced for intravenous patient-controlled analgesia (PCA) during obstetric labor as an alternative to standard epidural analgesia (EDA). In Sweden, approximately 50% of primiparous women and 30% of multiparous women receive labor analgesia with EDA

Remifentanil and high thoracic epidural anaesthesia: a successful combination for patients with myasthenia gravis undergoing transsternal thymectomy - Volume 22 Issue • Epidural • Remifentanil • Practice • Survey. Abstract. Introduction: Epidural analgesia is widely recommended as method of choice for pain relief during labor whereas it is recommended to use remifentanil patient controlled analgesia only in the context of a randomized clinical trial For the comparison of remifentanil PCA vs. epidural/combined spinal-epidural, we included 10 trials with a total of 2983 participants (Table 3). Most of the included trials for the first two outcomes were assessed as 'high risk of bias' and the estimated effect was not robust for satisfaction with pain relief when 'high risk of bias. Background: We hypothesised that intravenous patient‐controlled analgesia (IV PCA) with remifentanil could provide as satisfactory pain relief for labour as epidural analgesia. Methods: Fifty‐two parturients with singleton uncomplicated pregnancies were randomised to receive either IV PCA with remifentanil or epidural analgesia with 20 ml levobupivacaine 0.625 mg/ml and fentanyl 2 μg/ml. What is remifentanil? Remifentanil is a strong opioid painkiller that wears off quickly (OAA, 2019).. Why is remifentanil used? Your caregiver might suggest remifentanil as an alternative to an epidural if you can't have one of those (OAA, 2019).Reasons for not being able to have an epidural can include blood clotting issues or back issues (Royal Berkshire NHS Foundation Trust, 2016)

As glycine is present in its formulation, remifentanil is contra-indicated for epidural and intrathecal use. Patients with known hypersensitivity to any component of the preparation and other fentanyl analogues. Pharmokinetics Remifentanil is an opioid with a very short biological half-life that is susceptible to inactivation b Therapeutic Effects:Analgesia Anesthesia Implications Remifentanil should be followed by another treatment for pain postoperatively due to its short duration after discontinuation. Bolus doses are not recommended Very synergistic with other anesthetic agents - so may need to be reduced in the presence of propofol, isoflurane, and midazolam by up to 75%. midazolam decreases remifentanil dose Maintenance of anesthesia in morbidly obese patients using propofol with continuous BIS-monitoring: a comparison of propofol-remifentanil and propofol-epidural anesthesia. van Kralingen S(1), van de Garde EM, van Dongen EP, Diepstraten J, Deneer VH, van Ramshorst B, Knibbe CA The researchers found that the proportions of epidural conversion were 19 and 41 percent in the remifentanil PCA and pethidine groups, respectively (risk ratio, 0.48). During the study there were.

(PDF) Labor Analgesia

Remifentanil produced only moderate pain relief that was associated with a return of pain scores to baseline within three hours of treatment. 3 Two studies compared the efficacy of remifentanil to epidural analgesia, although both had limitations Remifentanil is the first ultra-short-acting opioid that can be rapidly titrated for various levels of surgical stimuli [1-5].Relatively large doses can be administered, which assures deep intra-operative analgesia and stability of intra-operative haemodynamics while permitting rapid extubation and awakening at the end of the procedure Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments

[Full text] Advantages of the Combination of Conscious

Intravenous Remifentanil versus Epidural Ropivacaine with

parturient clients for whom the use of neuraxial anesthesia (epidural and spinal blockade) is not an option. In these case an alternative option, that warrants consideration for patient centered anesthesia practice is the use of remifentanil (ultiva). Guidelines for the use of remifentanil in obstetric patients are sparse Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis Guolin Lu*, Wenshui Yao, Xiaofen Chen, Sujing Zhang and Min Zhou Abstract Background: Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief

Non-regional analgesia for labour: remifentanil in obstetric

Remifentanil Versus Thoracic Epidural Analgesia in Lung

  1. Postoperative analgesia until the first postoperative morning was performed with remifentanil target-control infusion for all patients. From that time remifentanil was stopped and continuous intravenous analgesia with morphine or double epidural analgesia with ropivacaine 0.3% was initiated (T0 = beginning of study)
  2. istration procedure, fast effect onset and
  3. istered at a dose of 25 ughour via TCA (target controlled analgesia) pump in Group P. In Group E, additionally, 0.0125% bupivacaine was ad
  4. Introduction. Epidural analgesia is considered to be the most effective method of pain relief during labour and is often the preferred choice of analgesia. 1 Intramuscular or intravenous opioids can provide an alternative in situations where regional analgesia is unavailable or contraindicated or if less invasive methods are preferred by the woman or obstetrician. 2 Remifentanil is a potent µ.
  5. e women's satisfaction with pain relief using patient controlled analgesia with remifentanil compared with epidural analgesia during labour. Design Multicentre randomised controlled equivalence trial. Setting 15 hospitals in the Netherlands. Participants Women with an intermediate to high obstetric risk with an intention to deliver vaginally
  6. istration of remifentanil was used to provide fetal immobilization and analgesia
  7. Remifentanil by patient controlled analgesia compared with epidural analgesia for pain relief in labour: 120

Intravenous Remifentanil Anesthesiology American

We randomised 418 women, of whom 409 could be followed for the primary endpoint. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference −0.50; 95% CI −6.8 to 5.9) Remifentanil for procedural sedation: a systematic review of the literature. Emerg. Med. J. 34, 294-301. 10.1136/emermed-2016-206129 [Google Scholar] Klimek M., Rossaint R., van de Velde M., Heesen M. (2018). Combined spinal-epidural vs. spinal anaesthesia for caesarean section: meta-analysis and trial-sequential analysis We randomised 418 women, of whom 409 could be followed for the primary endpoint. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference -0.50; 95% CI -6.8 to 5.9)

A Comparison of Remifentanil Parturient-Controlled

The decrease in pain scores was sustained in the epidural group whereas in the remifentanil group pain scores increased over time. Oxygen saturation was significantly lower in the remifentanil group after one hour of treatment compared to the epidural group (95.2 +/- 2.4% vs. 99.0 +/- 1.1%, P<0.01) Costs of epidural analgesia and remifentanil PCA are not significantly different. From an economic perspective, there is no preferential pain treatment in labouring women. Epidural analgesia is associated with a greater incidence of fever and significantly higher temperature overall The trial found that remifentanil intravenous PCA halved epidural analgesia conversion rate, compared with intramuscular pethidine.10 The importance of combining qualitative evidence that explores the views and experiences of service users alongside quantitative evidence to inform safety, effectiveness and cost of interventions to inform. Introduction. Remifentanil patient-controlled analgesia (RPCA) has been demonstrated to be an effective method of pain relief with favorable pharmacokinetic properties for women during labor 1-6.Remifentanil is an ultra short-acting μ-opioid that is metabolized rapidly through non-specific tissue esterases in adults and newborns 6-8.Its half-life is 3 min, and it is mainly eliminated in the. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference -0.50; 95% CI -6.8 to 5.9). Among women who actually received analgesia, these values were 23 and 35, respectively (mean.

Remifentanil for labour analgesia: time to draw breath

Labour pain with remifentanil patient-controlled analgesia versus epidural analgesia: a randomised equivalence tria Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed, including the continuous infusion of remifentanil BACKGROUND: Although epidural anaesthesia has become a standard method for labour analgesia all over the world, it is far from being ideal because of side effects and contraindications. Many alternative techniques have therefore been proposed, including the continuous infusion of remifentanil Some hospitals offer remifentanil, which is a very strong, short-acting painkiller given via a drip that you can control yourself using a machine. For more details, see our articles about intramuscular opioids and remifentanil. Epidural. Epidural analgesia is a local anaesthetic injected into the space between two vertebra in your back Seldom has a trial in women giving birth led to so much media response as the one by Wilson et al. published in The Lancet recently 1.They demonstrated in this open-label, multi-centre, randomised controlled trial that the use of intravenous remifentanil patient-controlled analgesia (PCA) instead of intramuscular pethidine halved the proportion of women needing epidural analgesia for.

Inadvertent epidural administration of remifentanil

Because remifentanil contains glycine (15 mg glycine per 1 mg remifentanil), which is an inhibitory neurotransmitter, it is not recommended for injection in the epidural or intrathecal space . Comparison of remifentanil with other intravenous opioids and epidural analgesia (Table 1 Kan et al. infused remifentanil at 0.1 μg · kg −1 · min −1 after establishing an epidural block and deliberately delayed skin incision for at least 15 min to establish a steady state concentration of remifentanil at delivery. This contrasts with our study, in which we gave a single bolus and avoided an infusion with the intention of. Remifentanil Hydrochloride for injection is contraindicated: For epidural or intrathecal administration due to the presence of glycine in the formulation [see Nonclinical Toxicology (13)]. In patients with hypersensitivity to remifentanil (e.g., anaphylaxis) [see Adverse Reactions (6.2)]. Warnings and Precautions Addiction, Abuse, and Misus

A randomised comparison of intravenous remifentanil

Remifentanil - Wikipedi

  1. the urine. Remifentanil has a rapid onset of action (time Key Message Offering remifentanil patient-controlled analgesia alongside epidural analgesia for pain relief during labor gives women a choice in pain relief that can add to their general satisfaction with labor and delivery
  2. Remifentanil PCA is now the analgesic choice in almost 30% of our deliveries, and since its introduction, the epidural rate in our unit has dropped by one third. There are risks with all methods of analgesia but we consider our experience, attained over several years, demonstrates that with strict protocols in place and one-to-one midwifery.
  3. istration through patient controlled analgesia (PCA) [2]
  4. istered similarly to an epidural. You're given the drug via a drip in.
  5. istration, intraoperative remifentanil infusion and sevoflurane anaesthesia, with postoperative epidural analgesia proved satisfactory. We review the recent literature and suggest that remifentanil is a useful addition to the armamentarium of the anaesthetist in the management of a patient with.
  6. Although remifentanil is a category C drug for use in pregnancy, it is increasingly being recognised as a valid form of analgesia for a woman who may be unable to have an epidural for labour, for either medical reasons or maternal preference. Once prescribed, in accordance with the Auckland DHB Medications - Prescribing policy, an
  7. Background: Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to.
The Heath Birth Centre, Royal Free Hospital, HampsteadThe Midwifery Led Unit, Lagan Valley Hospital - Which?

Unsatisfactory analgesia would occur frequently during repeated cesarean section under epidural anesthesia. The aim of this study is to observe the effects of intravenous remifentanil on maternal comfort, maternal and neonatal safety during repeated cesarean section under epidural anesthesia. A total of 80 parturients undergoing repeated cesarean section were involved in the study Epidural analgesia remains the gold standard during labour, but is contraindicated in several clinical settings due to increased risk of serious complications. There are few effective alternatives to epidural analgesia. However, there is an increasing interest for the use of remifentanil as a labour analgesic. In this focused review, we describe the effect, dose and safety of remifentanil for.

Remifentanil for labour analgesia: a meta-analysis of

  1. Matthew Wilson and colleagues 1 found that remifentanil patient-controlled analgesia halved the proportion of epidural conversions compared with intramuscular pethidine. We believe there was a flaw in this research because the study lacked data on birth order, and primigravidae report more pain than multiparous women. 2 We believe that addressing this issue could further increase the value of.
  2. August 15,2018, Healio . Women in labor receiving IV remifentanil patient-controlled analgesia were half as likely to need a subsequent epidural than those receiving intramuscular pethidine injection, which is the current standard of care, according to data published in The Lancet. Previous studies have shown that at least one in three women given pethidine to manage pain during labor.
  3. Evidence suggests that remifentanil patient-controlled analgesia (PCA) reduces epidural conversion rates compared to pethidine; however, no trial has yet investigated this as a primary endpoint. We are, therefore, comparing pethidine intramuscular injection to remifentanil PCA in a randomised controlled trial
  4. Epidural analgesia is associated with a greater incidence of fever and significantly higher temperature overall. Patient controlled remifentanil has an effect on maternal SpO2 with significantly lower mean SpO2 during the labour period
  5. Of women primarily treated with remifentanil, 13% (53/402) converted to epidural analgesia, while in women primarily treated with epidural analgesia 1% (3/296) converted to remifentanil. The area under the curve for total satisfaction with pain relief was 30.9 in the remifentanil group versus 33.7 in the epidural analgesia group (mean.
  6. istration of remifentanil was used to provide fetal immobilization and analgesia
  7. istered combined spinal epidurals at the L3/4 interspace, with 0.5% hyperbaric bupivacaine.

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled tria A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg;118(3):589-97. Stourac, P., Kosinova, M., Harazim, H., et al. (2016). The analgesic efficacy of remifentanil for labour The total time-weighted pain appreciation score for the remifentanil PCA group was 25.7, versus 36.8 in the epidural group (P = .001). Although the analysis was based on intention to treat, Dr. Freeman noted that 53 of the women in the self-administered pain relief group requested epidurals while in labor

Accidental administration of the remifentanil formulation

  1. Placebo Comparator: Epidural analgesia Patients will received continuous epidural analgesia starting from labour pain until deliver
  2. e whether remifentanil is effective for labor analgesia when compared with standard treatment (epidural analgesia)
  3. The maximum forearm-finger gradients were lower (less vasoconstriction) in the remifentanil group when compared to the gradients in patients with epidural analgesia (1.4 ± 1.8 vs 3.0 ± 1.7, respectively; P < 0.001).ConclusionOur results are consistent with the theory that low-dose opioids inhibit fever in patients not given epidural analgesia
  4. utes and suited to patient controlled ad

Remifentanil is a patient-controlled analgesia (PCA). It is a strong morphine-like painkiller that works very quickly and wears off equally as quickly. Although it cannot provide total pain relief it has been shown to significantly reduce pain from contractions. Remifentanil is given in small doses through a tube placed in one of your veins intravenous remifentanil-assisted epidural group (group R) or the epidural group (group E). Criteria for inclusion and exclusion Patients undergoing repeated cesarean section, with full-term, singleton pregnancies, who had arranged for epi-dural anesthesia, were included in this study. Patients with contraindications for epidural anesthesia. Conclusion: PCA intravenous remifentanil is an effective option for pain relief with minimal maternal and neonatal side effects in labor for preeclamptic patients with contraindications to epidural analgesia or requesting opioid analgesia. Keywords: Preeclampsia, PCA remifentanil, epidural, labor analgesia INTRODUCTION: The aim of this study was to compare patient satisfaction between remifentanil patient-controlled analgesia (RPCA) and epidural analgesia (EA) for labor pain. MATERIAL AND METHODS: This prospective cohort study was carried out on primiparous women requesting analgesia for labor at a Teaching Hospital, Amsterdam, the Netherlands

RESULTS:: Forty women were recruited to the following groups: remifentanil n = 19 (1 exclusion), epidural n = 20. Four crossed over: 3 from the remifentanil to epidural group and 1 from the epidural to remifentanil group. Mean (± SD) baseline NRS pain scores were similar, 8.4 ± 1.5 for remifentanil and 8.7 ± 1.2 for epidural analgesia, P = 0.52 Objective. To assess if there is a difference in duration of labor, the mode of delivery, average Visual Analog Scale (VAS) pain scores, maternal overall satisfaction with analgesia, side effects and neonatal outcomes in nulliparous women who received early labor analgesia with either epidural, patient-controlled IV analgesia (PCIA) with remifentanil or combined spinal-epidural (CSE) techniques A combined epidural-general anaesthetic technique, with remifentanil supplementation, enabled us to avoid unnecessary neuromuscular blocking drugs and prolonged intensive care, which had been anticipated. The potential benefits of remifentanil and epidural analgesia in neonates are discussed. Br J Anaesth 1999; 82: 774- 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.

Group C: remifentanil based general anesthesia followed by epidural for postoperative analgesia (8 patients). RESULTS: The demographic data, age and M/F distribution were comparable in the three groups. The remifentanil group showed less utilization of muscle relaxant (Cisatracurium) with respect to other groups (p < 0.001) An economic analysis of patient controlled remifentanil and epidural analgesia as pain relief in labour (RAVEL trial); a randomised controlled trial Liv Freeman * , Johanna Middeldorp, Eline van den Akker, Martijn Oudijk, Caroline Bax, Marloes van Huizen, Celine Radder, Bianca Fong, Kitty Bloemenkamp, Albert Dahan, Michel Struys , Ben Willem.

Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient-controlled delivery device, and pethidine given by intramuscular injection. This NIHR-funded study is. Any woman in labour can request to use remifentanil PCA. However, it is advisable a woman with an allergy to morphine, pethidine or other related drugs does not use remifentanil. Remifentanil may be useful also in certain situations when a woman cannot have an epidural. Having tried remifentanil does not limit your choice of pain relief in labour Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis BMC Pregnancy and Childbirth , Mar 2020 Guolin Lu , Wenshui Yao , Xiaofen Chen , Sujing Zhang , Min Zho Remifentanil Remifentanil 2015-10-31 00:00:00 Reactions 1575, p181 - 31 Oct 2015 Apnoea: case report A 63-year-old man developed apnoea during treatment with TCI (target-controlled infusion) remifentanil. The man underwent major abdominal cancer surgery under general anesthesia combined with thoracic epidural analgesia for postoperative pain

The Delivery Suite, Bedford Hospital - Which?The Delivery Suite, Colchester General Hospital - Which?The Central Delivery Suite, Scunthorpe General Hospital
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