The Antiapoptotic Effect of Remifentanil on the Immature Mouse Brain

Abstract

The present data indicate that at a supraclinical concentration C.P. remifentanil had no pronecrotic effect but exerted ex vivo antiapoptotic action on the immature mouse brain, involving the opioid and NMDA receptors, and the mitochondrial-dependent apoptotic pathway. Assessment of the impact of the antiapoptotic effect of remifentanil in in vivo neonatal mouse models of brain injury will also be essential to measure its consequences on the developing brain.

Effect of Anesthesia on the Developing Brain: Infant and Fetus

“…[41] . Because opioids, and specifically remifentanil [42] , have not been demonstrated to cause neuroapoptosis, this combination of drugs represents the most plausible approach to study in comparison to standard anesthetic technique, e.g. sevoflurane, to assess whether any differences in neurodevelopmental outcome exist.…”

General Anesthesia With Dexmedetomidine and Remifentanil in a 3-Year-Old Child: An Alternative Anesthetic Regimen to Allay Parental Concerns of the Potential Neurocognitive Effects of General Anesthesia

“…Furthermore, the opioids have been shown in laboratory animals to have limited pro-apoptotic effects [2][3][4][5]. In particular, remifentanil has been shown to have neuroprotective effects during ischemia in laboratory animals and potentially the ability to blunt the pro-apoptotic effects of other agents [23][24][25].…”

“…When choosing this anesthetic, several concerns were encountered including whether premedication with midazolam should be used given concerns regarding benzodiazepines and their agonism at GABA receptors. Although our common practice includes the use of oral midazolam for anxiolysis to prevent separation anxiety, alternatives include parental presence or the use of other distraction techniques to avoid the need for such medications [24,26]. Alternatively, although onset times may be longer than oral midazolam, both oral and intranasal dexmedetomidine have been used for premedication prior to anesthetic induction.…”

Preventing neurotoxicity: don't forget high‐dose narcotic anesthetic

“…It has all the advantages of high-dose fentatnyl, without the prolonged postoperative effects. And there is recent evidence to suggest that remifentanil may not only be devoid of neurodegenerative effects, but that it may provide an antiapoptotic effect (2).…”

“…In the absence of a consent form for anesthesia, various professional bodies have recommended the documentation of preoperative discussion and verbal consent. Caudal analgesia is the most common regional technique performed in children and has an excellent safety record (2). However, adequate information should be given regarding the technique, side effects, and potential complications to allow an informed consent (3), which should be documented.…”