Remifentanil infusion for major abdominal surgery in small infants

Wee, L.; Moriarty, A.; Cranston, Alistair; Bagshaw, Oliver

doi:10.1046/j.1460-9592.1999.00419.x

Cited by 53 publications

(40 citation statements)

References 13 publications

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“…, caused bradycardia and hypotension, findings not observed after infusion of 0.25 µg·kg 23 None of our patients experienced severe bradycardia or hypotension requiring intraoperative treatment, despite receiving relatively higher infused doses of remifentanil, a finding that may have been due to the absence of a loading dose. This finding is in agreement with those of a previous study, 10 which found that intraoperative heart rate was significantly lower in patients administered propofol/remifentanil than in those administered sevoflurane, with no patient treated for hemodynamic depression with atropine, phenylephrine, or ephedrine even when administered high infused doses of remifentanil (0.8 µg·kg…”

Section: Discussionmentioning

confidence: 40%

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

et al. 2013

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Background: Intraoperative infusion of opioids has been associated with increased postoperative pain and analgesic requirements, but the development of tolerance in young children is less clear. This prospective, randomized, doubleblinded study was designed to test the hypothesis that the intraoperative administration of remifentanil results in postoperative opioid tolerance in a dose-related manner in young children. Methods: We enrolled 60 children (aged 1-5 yr) who were undergoing elective laparoscopic ureteroneocystostomy. Patients were randomized and received an intraoperative infusion of 0, 0.3, 0.6, or 0.9 µg·kg −1 ·min −1 remifentanil. Postoperative pain was managed by a parent/nurse-controlled analgesia pump using fentanyl. The primary outcome included the total fentanyl consumptions at 24 and 48 h postsurgery. Secondary outcomes were the postoperative pain scores and adverse effects. Results:The children who received 0.6 and 0.9 µg·kg −1 ·min −1 remifentanil required more postoperative fentanyl than the children who received saline or 0.3 µg·kg −1 ·min −1 remifentanil (all P < 0.001) for 24 h after surgery. The children who received 0.3-0.9 µg·kg −1 ·min −1 intraoperative remifentanil reported higher pain scores at 1 h after surgery than the children who received saline (P = 0.002, P = 0.023, and P = 0.006, respectively). No significant intergroup differences in recovery variables were observed, but vomiting was more frequent in the 0.9 µg·kg ·min−1 remifentanil to young children resulted in acute tolerance for 24 h after surgery in an apparently dose-related manner.T he unique pharmacodynamic and pharmacokinetic characteristics of remifentanil have increased its dominant intraoperative role in children.1,2 The context-sensitive halftime of remifentanil renders the offset for effect dose-independent, thus allowing prolonged infusion of large doses with little risk for delayed awakening or respiratory depression after surgery. 3,4 Similar to other potent opioids, however, intraoperative remifentanil may induce hyperalgesia and tolerance, manifesting as increased postoperative pain and analgesic requirements. [5][6][7] Opioid-induced hyperalgesia is a paradoxical pain sensitization of the nervous system whereby a patient receiving an opioid for the treatment of pain might actually have an increase in pain perception to noxious stimuli. 8 Tolerance is a pharmacologic concept defined as a progressive decrease in response to a drug and which can be overcome by increasing the dose of the drug. Although the difference between hyperalgesia and tolerance is difficult to tease out, opioid-induced hyperalgesia and tolerance may complicate the perioperative course of a patient who receives intraoperative opioid.In young children, however, only a few studies have investigated the development of tolerance after the intraoperative infusion of remifentanil, and the results were anecdotal and Intraoperative Infusion of 0.6-0.9 µg · kg

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Section: Discussionmentioning

confidence: 40%

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

et al. 2013

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“…Not surprisingly, these characteristics lead to a context-sensitive half-life that is constant, independent of its duration of infusion, even in neonates and infants [ 255 ]. However, evidence suggests that the rate of recovery after remifentanil in neonates less than 1 week old may be greater than it is in infants 7 days to 3 months of age [ 256 ]. Pharmacodynamically, remifentanil may induce bradycardia, an effect classically attributed to the parasympathomimetic properties of remifentanil, a direct negative chronotropic effect [ 257 ].…”

Section: Analgesiamentioning

confidence: 99%

Selection of Anesthesia Techniques for the Neonate

Sabourdin

Louvet

Constant

2014

Neonatal Anesthesia

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“…The studies reported satisfactory results regarding efficacy and safety. [123][124][125][126][127] Experience and evidence from intensive care medicine demonstrate no accumulative effects of remifentanil used for sedation and analgesia. The drug seems to be safely administered to patients with reduced function of vital organs, even long time infusions are well tolerated without accumulative effects.…”

Section: Remifentanilmentioning

confidence: 99%

Remifentanil as analgesia for labour pain

Tveit

2013

Acta Anaesthesiol Scand

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Background To collect updated information about pharmacological labour analgesia in Norway, especially systemic opioids and epidural. Evaluation of efficacy and safety with remifentanil intravenous patient‐controlled analgesia (IVPCA) for pain relief during labour. To compare remifentanil IVPCA with epidural analgesia (EDA) regarding efficacy and safety during labour. Methods In paper I, two national surveys identified Norwegian labour analgesia methods and changes during the study period (2005–2008). Paper II is a prospective, observational study of analgesic efficacy and safety with remifentanil IVPCA. Paper III is a prospective, randomized controlled trial comparing remifentanil IVPCA with EDA regarding analgesic efficacy and safety. Results The surveys in paper I found the frequency of EDA in Norwegian hospitals to be increasing, but still low (25.9%) compared with other western countries. Nitrous oxide and traditional systemic opioids, like pethidine, were frequently used. In paper II, remifentanil IVPCA was found to give satisfactory labour analgesia in more than 90% of the parturients with an average maximal pain reduction of 60%. Maternal oxygen desaturation and sedation were acceptable, and neonatal data reassuring. In paper III, a randomized controlled trial found remifentanil IVPCA and EDA to be comparable both regarding analgesic efficacy (pain reduction; Fig. ) and maternal satisfaction. Remifentanil IVPCA produced more maternal sedation and oxygen desaturation; neonatal outcome was reassuring in both groups. Reduction in pain score [visual analogue scale (VAS)] during labour analgesia with patient‐controlled intravenous remifentanil and continuous epidural infusion with ropivacaine and fentanyl. Conclusion The frequency of epidural labour analgesia in Norway has increased, but is still relatively low. Nitrous oxide and traditional systemic opioids are frequently used. The clinical practice seems conservative; newer short‐acting opioids are seldom used for systemic labour analgesia. The studies on remifentanil IVPCA revealed adequate pain relief, high maternal satisfaction, and no serious neonatal side effects. There were no differences in analgesic efficacy, maternal satisfaction, and neonatal outcome when comparing remifentanil IVPCA with EDA. However, remifentanil caused maternal sedation and oxygen desaturation. We recommend the use of IVPCA remifentanil as labour analgesia instead of traditional opioids as pethidine and morphine when EDA is not an option. The presence of skilled personnel and close monitoring is mandatory.

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Remifentanil infusion for major abdominal surgery in small infants

Cited by 53 publications

References 13 publications

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

Intraoperative Infusion of 0.6–0.9 µg · kg−1 · min−1 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy

Selection of Anesthesia Techniques for the Neonate

Remifentanil as analgesia for labour pain

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