Remifentanil for Sedation of Children With Traumatic Brain Injury

Hungerford, James; O’Brien, Nicole; Moore‐Clingenpeel, Melissa; Sribnick, Eric A.; Sargel, Cheryl; Hall, Mark W.; Leonard, Jeffrey R.; Tobias, Joseph D.

doi:10.1177/0885066617704390

Cited by 5 publications

(3 citation statements)

References 21 publications

(26 reference statements)

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“…However, multiple practice survey and intra-analgesic class comparative studies do describe IV opioids as the primary analgesic class used across the spectrum of critically ill pediatric patients (3,5,33,61,62). A variety of IV opioids have been used in this setting including fentanyl, morphine, hydromorphone, and remifentanil (63)(64)(65)(66)(67)(68)(69). Due to lack of active metabolites, fentanyl may be preferred in the setting of renal dysfunction.…”

Section: Pharmacologic Management Of Painmentioning

confidence: 99%

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Smith

Besunder

Betters

et al. 2022

Pediatric Critical Care Medicine

205

212

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RATIONALE:A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available. OBJECTIVE:To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility. DESIGN:The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to. METHODS:Taskforce content experts separated into subgroups addressing pain/ analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as "strong" with "we recommend" or "conditional" with "we suggest. " Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence. RESULTS:The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements.

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Section: Pharmacologic Management Of Painmentioning

confidence: 99%

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Smith

Besunder

Betters

et al. 2022

Pediatric Critical Care Medicine

205

212

View full text Add to dashboard Cite

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“…RFT is a p ο tent μ-opioid analgesic with advantages in rapid blood–brain barrier equilibration time over other opioids [ 29 ]. Currently, besides the commonly known acute opioid tolerance and postoperative hyperalgesia that RFT can achieve, people usually make a connection between the use of RFT and rapid deep sedation and pain relief for patients with various injuries [ 30 , 31 ]. Some scholars, albeit with no direct evidence provided by experiments, have taken it plausible that RFT can reduce the risk of acute kidney injury [ 32 ].…”

Section: Cell Culturementioning

confidence: 99%

Remifentanil attenuates sepsis-induced intestinal injury by inducing autophagy

et al. 2021

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Remifentanil (RFT), extensively used for general anesthesia, is a synthetic ultra-short-acting opioid used as an anti-inflammatory oxidant to alleviate a plethora of diseases. This study was designed to determine whether RFT would provide protective effects on sepsis-induced intestinal injury.The determination of cell viability and inflammation of LPS-treated IEC-6 cells influenced by RFT was conducted by Cell counting Kit-8 (CCK-8), RT-qPCR, and western blot, while the detection of LDH, diamine oxidase (DAO), and intestinal-type fatty acid binding proteins (I-FABP) was conducted for determining the intestinal cytotoxicity in these cells. The apoptosis of these cells was detected by TUNEL, with autophagy-related protein expression measured by western blot to confirm whether autophagy was activated. Finally, the aforementioned assays were conducted again after 3-Methyladenine (3-MA), an autophagy inhibitor, was used on these cells to investigate whether RFT exerted its effects on LPS-treated IEC-6 cells via modulation of autophagy.RFT alleviates LPS-induced IEC-6 cell inflammation, cytotoxicity and apoptosis, and autophagy-related proteins were expressed at higher levels when RFT was used on these cells. Nevertheless, further treatment of 3-MA weakened the restorative impacts of RFT on the inflammation, cytotoxicity and apoptosis of these cells.To conclude, this paper is the first to present evidence that RFT attenuates sepsis-induced intestinal injury by inducing autophagy, which will provide instructions for the future investigations into the use of RFT in treatment of intestinal injury.

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“…It is important to remember some general rules: the causes of acute sudden coma are most often the intake of various drugs or traumatic brain damage -hemorrhage, trauma or hypoxia; subacute development is usually due to previous therapeutic or neurological conditions, including secondary cerebral edema, occurring around a pre-existing lesion [11,12]. Thus, it can be concluded that the existing etiological classifications of coma are not convenient for use in an intensive care situation and only complicate the choice of the optimal tactics for conducting intensive therapy.…”

mentioning

confidence: 99%

Optimization of Intensive Therapy in Patients in the Acute Period of Coma

Volkova

Maksym

2021

RS Global - World Science

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When prescribing intensive care to an unconscious patient, it is important to determine the etiological factor of the critical condition. The distribution of patients by neurotropic or vasotropic mechanism of disturbance of consciousness is extremely important for successful treatment and prevention of complications. Determination of autoantibodies to brain tissue is an important diagnostic criterion for the adequacy of intensive care. Administration of substances with succinic acid and D-fructose-1,6-diphosphate sodium salt hydrate is pathogenetically determined in this category of patients.

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Remifentanil for Sedation of Children With Traumatic Brain Injury

Abstract: This data suggest that remifentanil is a suitable sedative agent for use in children with TBI. It provides a rapid onset of sedation with recovery that permits reliable and reproducible clinical examination.

Cited by 5 publications

References 21 publications

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Remifentanil attenuates sepsis-induced intestinal injury by inducing autophagy

Optimization of Intensive Therapy in Patients in the Acute Period of Coma

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