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                     <i>Intravenous Remifentanil</i> </b>

Kan, Randall E.; Hughes, Samuel C.; Rosen, Mark A.; Kessin, Charlize; Preston, Paul; Lobo, Errol

doi:10.1097/00000542-199806000-00008

Cited by 302 publications

(32 citation statements)

References 19 publications

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“…Furthermore, a dose-related risk of respiratory depression and excessive sedation exist after remifentanil bolus injection, which has been discovered in healthy volunteers [29]. Some studies have recommended the bolus dose of 0.4 µg·kg −1 can be used effectively and securely [6], [8], [18], [26], [30], the infusion rate more than 0.05 µg·kg −1 ·min −1 may be connected with higher incidence of side effects [14].…”

Section: Discussionmentioning

confidence: 99%

“…Our findings seemed to be different from previous studies [6], [7], [9], [14], [26], [35], which found no effect from remifentanil on neonatal outcomes including umbilical pH and base excess. Despite the fact that remifentanil is easy to be metabolized in the neonates [30], [37], it still has some influence on neonatal status. Therefore, we recommended neonatal resuscitation should be in train before birth for the neonates whose mothers have received remifentanil.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Lin

Tao

et al. 2014

PLoS ONE

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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. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (P<0.0001), and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P<0.0001) and a higher sedation score (P<0.0001) within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8±0.4 vs. 3.7±0.6, P = 0.007) and pain relief score (2.9±0.3 vs. 2.8±0.4, P<0.0001) compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P<0.0001) was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Lin

Tao

et al. 2014

PLoS ONE

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“…Several studies have investigated the pharmacodynamics of Remifentanil and found it to be 20–40 times more potent than Alfentanil and nearly equipotent with Fentanyl [18, 19]. Remifentanil is rapidly metabolized by nonspecific tissue esterases in blood and other tissues including the brain, liver, placenta, and GI tract [20–22]. However, we found no study investigating the existence of enzymatic degradation of Remifentanil in subcutaneous tissues.…”

Section: Discussionmentioning

confidence: 85%

Accidental Subcutaneous Remifentanil Infusion as a Cause of Delayed Awakening after Craniotomy

Wolfson

Swamidoss

2011

Case Reports in Anesthesiology

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“…Previous studies have shown a significant amount of transfer of remifentanil across the placenta (Welzing et al, 2011; Heesen et al, 2013). However, there is also rapid metabolism and redistribution of remifentanil Kan et al (1998). have shown an umbilical vein: maternal serum (UV:MA) ratio of 0.88 ± 0.78 and an umbilical artery: umbilical vein ratio of 0.29 ± 0.07.…”

Section: Discussionmentioning

confidence: 99%

Exploring the Pharmacokinetic Profile of Remifentanil in Mid-Trimester Gestations Undergoing Fetal Intervention Procedures

et al. 2017

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Background: Indications for surgery during pregnancy have increased. Specifically fetal interventions have increased from conditions that were considered lethal like twin-twin transfusion syndrome and severe fetal anemia to non-lethal conditions like myelomeningocele. The optimal anesthetic agent for in utero surgery is yet to be determined. Success of the procedure is often dictated by the efficacy of the anesthetic to immobilize the fetus without over-sedating mom. Remifentanil is used as preferred agent due to its short half-life however pharmacokinetics in pregnancy is unknown.Objective: To determine the pharmacokinetic parameters of remifentanil in a mid-trimester pregnant patient population undergoing fetal intervention.Study Design: A validated liquid chromatography assay with ultraviolet absorbance was employed to estimate maternal serum remifentanil levels. Blood samples were obtained at baseline and at selected time points: 5, 15, 30, 45, 60 min after the beginning of the remifentanil infusion and at 15, 30, and 60 min post end of infusion.Results: Ten pregnant patients were enrolled in the study however only eight patients had sampling obtained at all time points. The mean gestational age was 22.2 (±2.7) weeks, maternal age was 27.8 (±5.1) years and body mass index was 29.6 (±6.3). After receiving a continuous infusion of remifentanil, mean total dose was 975.3 μg, Cmin was 2.0 ng/mL and Cmax was 8.4 ng/mL. A two-compartment model best described the plasma remifentanil data. Mean pharmacokinetic parameters were: volume of distribution (Vdc) = 124.6 L (16.2–530.8 L), maternal remifentanil total clearance (Clt) = 170.7 L/h (17.7–486.9 L/h), and half-life (t½) = 0.6 h (0.2–0.9 h). The maternal remifentanil area under the curve (AUC) ranged from 2.7 to 21.7 μg/L*h. The mean alpha-acidic glycoprotein was 124.8 mg/dL (81.3–149.8).Conclusion: The pharmacokinetic profile of remifentanil in pregnant women is similar to previously reported general population profiles. This data did provide potential rationale for the clinical observations why when remifentanil is dosed based on non-pregnant guidelines, it did not uniformly provide adequate fetal immobilization as per anecdotal perception of operating fetal surgeons. These findings are important for the development of further clinical studies to optimize dosing for surgery during pregnancy including the estimation of placental transfer and total fetal exposure.

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Intravenous Remifentanil

Abstract: Remifentanil crosses the placenta but appears to be rapidly metabolized, redistributed, or both. Maternal sedation and respiratory changes occur, but without adverse neonatal or maternal effects.

Cited by 302 publications

References 19 publications

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Accidental Subcutaneous Remifentanil Infusion as a Cause of Delayed Awakening after Craniotomy

Exploring the Pharmacokinetic Profile of Remifentanil in Mid-Trimester Gestations Undergoing Fetal Intervention Procedures

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