Early awakening and extubation with remifentanil in ventilated premature neonates

Silva, Yerkes Pereira e; Gomez, Renato Santiago; Marcatto, Juliana de Oliveira; Máximo, Thadeu Alves; Barbosa, Rosilu Ferreira; Silva, Ana Cristina Simões e

doi:10.1111/j.1460-9592.2007.02378.x

Cited by 34 publications

(20 citation statements)

References 29 publications

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“…Unfortunately, many premedication regimens are not well evaluated in prospective trials in the neonate, and hence the most appropriate selection and indeed the safety of some of these medications in this population remain unclear. This double-blind randomised controlled trial adds to a growing body of evidence on the use of remifentanil in neonates and very low birthweight infants, which, to date, has been very limited 10 13–15 20 21. While our results demonstrate that remifentanil combined with atropine maintained haemodynamic and oxygenation parameters comparable to the traditional regimen of fentanyl, succinylcholine and atropine, the intubation conditions reported by intubators were felt to be less optimal with remifentanil.…”

Section: Discussionmentioning

confidence: 99%

“…Remifentanil has a rapid onset of action (60–90 s) and at adequate doses renders the patient apnoeic and motionless, thus reducing the need for a muscle relaxant 12. The experience with remifentanil in the neonatal literature to date is extremely limited; however, earlier reports suggest that remifentanil may provide adequate sedation, analgesia and intubation conditions in this population 13–15. The objective of this trial was to evaluate the safety and efficacy of remifentanil in term and preterm neonates undergoing non-urgent endotracheal intubation.…”

mentioning

confidence: 99%

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Remifentanil for endotracheal intubation in neonates: a randomised controlled trial

Choong

AlFaleh

Doucette

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Remifentanil for endotracheal intubation in neonates: a randomised controlled trial

Choong

AlFaleh

Doucette

et al. 2010

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Besides, several studies have demonstrated the safety and efficacy of remifentanil in analgesia and anesthesia of newborns, at term and premature 32,33,58 . Since remifentanil does not have residual sedation after it is discontinued, it became an option for sedation and analgesia of premature neonates 59,60 .…”

Section: Resultsmentioning

confidence: 99%

“…Assim, vários estudos têm mostrado a segurança e eficá-cia do remifentanil na analgesia e anestesia de crianças e recém-nascidos, assim como em recém-nascidos prematuros 32,33,58 . Como o remifentanil não apresenta efeito de sedação residual após sua suspensão, pode-se tornar uma opção na sedação e analgesia de recém-nascidos prematuros 59,60 .…”

Section: Conclusãounclassified

Sedação e analgesia em neonatologia

Silva¹,

Gomez²,

Máximo³

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVOS:A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEÚDO:Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose) e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais). A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES:A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ ou submetidos a procedimentos invasivos, cirúrgicos ou não.

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“…It appears that the advantage of a short elimination in comparison with longer acting opioids also holds true with preterm babies. After termination of infusions of morphine or remifentanil in intensive care for respiratory distress syndrome, the length of time required to awaken and extubate the neonates was 18.9-and 12.1-fold longer, respectively, in the morphine group than in the remifentanil group (Silva et al 2008). The first of the four RCTs comparing remifentanil and pethidine in labour analgesia was interrupted due to the lower Apgar scores in the pethidine group in an interim analysis of the data (Volikas and Male 2001).…”

Section: Effects Of Maternal Analgesia On the Neonatementioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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Early awakening and extubation with remifentanil in ventilated premature neonates

Cited by 34 publications

References 29 publications

Remifentanil for endotracheal intubation in neonates: a randomised controlled trial

Remifentanil for endotracheal intubation in neonates: a randomised controlled trial

Sedação e analgesia em neonatologia

Intravenous patient-controlled analgesia with remifentanil in early labour

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