Experience with Remifentanil in Neonates and Infants

Welzing, Lars; Roth, Bernhard

doi:10.2165/00003495-200666100-00003

Cited by 39 publications

(36 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Remifentanil has an extremely brief action, high predictability, rapid onset and offset of action, and immediate recovery of the clinical effect after interruption of the administration [5]. The results of previous studies using remifentanil as single agent were also encouraging [6,7,8].…”

Section: Introductionmentioning

confidence: 99%

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

et al. 2016

View full text Add to dashboard Cite

Background: Neonatal intubation is stressful and should be performed with premedication. In the case of an INSURE (intubation/surfactant/extubation) procedure a short duration of action of the premedication used is needed to facilitate fast extubation. Given its pharmacological profile, remifentanil seems a suitable candidate. Objectives: The aim here was to evaluate the effect and side effects of remifentanil as a premedication for preterm neonates undergoing INSURE. Methods: A prospective, single-center study in a level III neonatal intensive care unit was conducted. The quality of sedation was assessed in preterm infants receiving remifentanil prior to intubation for the INSURE procedure. Intravenous remifentanil was administered quickly and followed by a saline flush in approximately 30 s. The quality of sedation was defined by a combination of adequate sedation score, good intubation conditions and absence of side effects. Results: The study was terminated after the inclusion of 14 patients because of the high rate of side effects and the poor intubation conditions. Adequate sedation was achieved in only 2 patients (14%). Six patients (43%) needed additional propofol to obtain adequate sedation. Chest wall rigidity occurred in 6 patients (43%). Conclusions: The rapid administration of remifentanil provides insufficient sedation and is associated with a high risk of chest wall rigidity in preterm neonates.

show abstract

Section: Introductionmentioning

confidence: 99%

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

et al. 2016

View full text Add to dashboard Cite

show abstract

“…8 Some pharmacokinetic investigations in older children and term infants have been done, but no pharmacokinetic data exist for remifentanil in preterm infants. 13 To extend the pharmacokinetic knowledge about remifentanil in children, we analyzed the degradation of remifentanil in umbilical cord serum of preterm and term infants. Our aim was to investigate whether the activity of nonspecific blood esterases depends on gestational age.…”

Section: Discussionmentioning

confidence: 99%

“…However, until now no pharmacokinetic data have existed about remifentanil in preterm infants. 13 Ethical restrictions in the volume of blood that can be withdrawn for kinetic sampling nearly prohibit pharmacoki-netic studies in preterm infants. However, in contrast to other opioids, the metabolism of remifentanil is almost independent of liver and renal function.…”

mentioning

confidence: 99%

Remifentanil Degradation in Umbilical Cord Blood of Preterm Infants

Welzing

Ebenfeld²,

Dlugay

et al. 2011

Anesthesiology

Self Cite

View full text Add to dashboard Cite

Background:No pharmacokinetic data about remifentanil in preterm infants exist, although remifentanil is increasingly used in this especially vulnerable subgroup of pediatric patients. Unfortunately, ethical restrictions in the volume of blood that can be withdrawn for kinetic sampling nearly prohibit pharmacokinetic studies in preterm infants. Methods: Because remifentanil is rapidly metabolized by nonspecific blood esterases, we collected umbilical cord serum of preterm and term infants to investigate whether the activity of nonspecific blood esterases depends on gestational age. Umbilical cord serum, buffer solution, ascorbic acid, and remifentanil were mixed in a glass vial placed in a shaking water bath at 37°C. Subsequently, serum samples were subjected to liquid chromatography-mass spectrometry-based analysis of remifentanil and its metabolite GR90291 after 0, 30, 60, 100, and 150 min. Results: We analyzed umbilical cord serum samples of 34 preterm infants (24 -36 gestational weeks) and six term infants. The degradation rates of remifentanil to its major metabolite GR90291 were comparable in preterm and term infants. The overall median degradation half-life of remifentanil was 143 Ϯ (interquartile range) 47 min (minimum, 76 min; maximum, 221min) without significant differences between very preterm infants (less than 28 gestational weeks)

show abstract

“…Although remifentanil is not recommended during the first year of life, it was shown to have a favorable safety and efficacy profile in neonates [155,156]. Remifentanil is currently used for the sedation of neonates during mechanical ventilation [157,158].…”

Section: Intravenous Remifentanilmentioning

confidence: 99%

Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

et al. 2017

View full text Add to dashboard Cite

Fentanyl and its derivatives sufentanil, alfentanil, and remifentanil are potent opioids. A comprehensive review of the use of fentanyl and its derivatives in the pediatric population was performed using the National Library of Medicine PubMed. Studies were included if they contained original pharmacokinetic parameters or models using established routes of administration in patients younger than 18 years of age. Of 372 retrieved articles, 44 eligible pharmacokinetic studies contained data of 821 patients younger than 18 years of age, including more than 46 preterm infants, 64 full-term neonates, 115 infants/toddlers, 188 children, and 28 adolescents. Underlying diagnoses included congenital heart and pulmonary disease and abdominal disorders. Routes of drug administration were intravenous, epidural, oral-transmucosal, intranasal, and transdermal. Despite extensive use in daily clinical practice, few studies have been performed. Preterm and term infants have lower clearance and protein binding. Pharmacokinetics was not altered by chronic renal or hepatic disease. Analyses of the pooled individual patients' data revealed that clearance maturation relating to body weight could be best described by the Hill function for sufentanil (R 2 = 0.71, B max 876 mL/min, K 50 16.3 kg) and alfentanil (R 2 = 0.70, B max (fixed) 420 mL/min, K 50 28 kg). The allometric exponent for estimation of clearance of sufentanil was 0.99 and 0.75 for alfentanil clearance. Maturation of remifentanil clearance was described by linear regression to bodyweight (R 2 = 0.69). The allometric exponent for estimation of remifentanil clearance was 0.76. For fentanyl, linear regression showed only a weak correlation between clearance and bodyweight in preterm and term neonates (R 2 = 0.22) owing to a lack of data in older age groups. A large heterogeneity regarding study design, clinical setting, drug administration, laboratory assays, and pharmacokinetic estimation was observed between studies introducing bias into the analyses performed in this review. A limitation of this review is that pharmacokinetic data, based on different modes of administration, dosing schemes, and parameter estimation methods, were combined.The online version of the original article can be found under

show abstract

Experience with Remifentanil in Neonates and Infants

Cited by 39 publications

References 71 publications

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

Remifentanil Degradation in Umbilical Cord Blood of Preterm Infants

Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

Contact Info

Product

Resources

About