Remifentanil use in children undergoing congenital heart surgery for left-to-right shunt lesions

Akpek, Elif; Erkaya, Cigdem; Dönmez, Aslı; Mercan, Şükrü; Esen, Asım; Aşlamacı, Sait; Arslan, G.

doi:10.1053/j.jvca.2004.11.011

Cited by 16 publications

(4 citation statements)

References 24 publications

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“…compared remifentanil 2 mcg·kg −1 followed by 2 mcg·kg −1 ·min −1 infusion vs fentanyl 20 mcg·kg −1 bolus followed by 20 mcg·kg −1 ·min −1 , both supplemented with midazolam 0.1 mg·kg −1 ·h −1 in 33 children (3 months–6 years) undergoing surgery for left‐to‐right shunting and pulmonary hypertension. The authors confirmed remifentanil safety in these patients who had no decrease in HR and blood pressure (BP) (32). Tirel et al.…”

Section: Pharmacodynamicsmentioning

confidence: 73%

Remifentanil in children

Sammartino

Garra

Sbaraglia

et al. 2010

Pediatric Anesthesia

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SummaryRemifentanil has gained the confidence of anesthesiologists and has given a real opportunity to change the way anesthesia is given. It can be considered the ideal opioid despite many obstacles to pediatric use: the condition of 'off-label', the lack of wide randomized clinical trials, and the fear of adverse events because of its high potency. Experiences in the field with this opioid over the years encouraged its use. Use has been associated with N 2 0 and volatile agents for general anesthesia and with propofol for total intravenous anesthesia (TIVA). It seems very useful for sedation inside and outside the operating room and in intensive care for both short painful procedures and synchronization with mechanical ventilation. However, its unique pharmacokinetic characteristics causing rapid onset and offset of effect appear unchanged in small children and even in premature neonates and need to be really confirmed by further pharmacokinetic studies. Moreover, the real risks of tolerance and hyperalgesia should be evaluated in the pediatric population. In this review, we go through the newer aspects of this versatile drug that has been proposed as 'the pediatric anesthetist's opiate'.Keywords: remifentanil; pharmacokinetics; pharmacodynamics; shortacting opioids; children; TCI Remifentanil can be considered the best answer to the search for the ideal opioid because of its unique pharmacokinetic characteristics, different from any other opioid (1-4). PharmacokineticsThe ester-linkage makes the compound susceptible to metabolism by nonspecific plasma and tissues esterases, independent from hepatic and renal function (5,6), and it can be safely used even in anhepatic period of liver transplantation or when facing with failure or immaturity of most parenchyma (7,8).Pharmacokinetics (PK) does not change in patients who are deficient in pseudocholinesterase activity, showing that it is not a good substrate for butyrylcholinesterase (9). Remifentanil has a rapid onset, small volume of distribution (Vd), rapid clearance (CL), and a brief half-time (1.0-1.5 min) for equilibration (t ½ Ke0) between plasma and the effect compartment (10). Its extremely short contextsensitive half-life (3-5 min) and the rapid recovery from drug effect are the hallmarks of remifentanil's unicity.

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Section: Pharmacodynamicsmentioning

confidence: 73%

Remifentanil in children

Sammartino

Garra

Sbaraglia

et al. 2010

Pediatric Anesthesia

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“…The hemodynamic effects of remifentanil were observed to be similar to those of a moderately high dose of fentanyl for open cardiac surgery in children. 73 A study of remifentanil for fast track cardiac anesthesia demonstrated a clinically unimportant decrease in systolic blood pressure that was similar to that of fentanyl and a decrease in HR that was greater than that of fentanyl. 74 In children without CHD, remifentanil caused a decrease in HR, an increase in SVR, and an associated reduction of CO that could be attenuated by pretreatment with atropine.…”

Section: Opioidsmentioning

confidence: 99%

Anesthetic Drugs in Congenital Heart Disease

Friesen

2014

Semin Cardiothorac Vasc Anesth

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The structural defects associated with the various forms of congenital heart disease lead to pathological and functional changes that place patients at risk for adverse events, and in fact the perioperative incidence of morbidity and mortality has been documented to be increased in children with congenital heart disease. Patients with congenital heart disease can present to the anesthesiologist in a relatively precarious state of balance of several hemodynamic factors, including preload, ventricular contractility, systemic vascular resistance, pulmonary vascular resistance, heart rate, and cardiac rhythm. Anesthetic drugs can affect each of these, and an ideal anesthetic drug for such patients does not exist. The purpose of this article is to review the hemodynamic effects of anesthetic drugs and how they may contribute to the occurrence of adverse events in children with congenital heart disease.

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“…This makes it an ideal agent for neonatal and infant anesthesia. There is no other drug than remifentanil with a greater clearance in neonates compared to older children [48]. …”

Section: Intravenous Agentsmentioning

confidence: 99%

Recent advances in pediatric anesthesia

Holzki

2011

Korean J Anesthesiol

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Writing about advances in a field of medicine normally includes some pride about progress which one was witness to or even a participant in. The younger one is, the more enthusiastically every advance is lauded and welcomed. This is human nature and nothing to be complained about. However, when anesthesiologists, having worked and struggled in the field of pediatric anesthesia for about 40 years, look back to past advances, a more realistic, even painful picture comes to mind. There was a price which a considerable number of patients had to pay for progress, ruined health or even death. This experience of decades of practice is rarely presented in the literature but should not be forgotten when we proudly remember advances in pediatric anesthesia.

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Remifentanil use in children undergoing congenital heart surgery for left-to-right shunt lesions

Cited by 16 publications

References 24 publications

Remifentanil in children

Remifentanil in children

Anesthetic Drugs in Congenital Heart Disease

Recent advances in pediatric anesthesia

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