Abstract
ObjectiveThis case series aimed to summarize our experience in usage of remifentanil in neonates undergoing non-cardiac surgery.BackgroundPhysiology of neonates and infants is different from that of adults. Immaturity of their vital organ systems narrows a safety margin of perioperative management including anesthesia. Remifentanil has favorable characteristics for pediatrics such as short duration of action and rapid elimination. Although remifentanil was introduced into clinical practice since 1996, its application to neonatal anesthesia has not been validated yet.MethodsThis is a 14-month retrospective case series of neonates receiving remifentanil during non-cardiac surgery at a tertiary care pediatric hospital in Japan. Patients’ characteristics, intraoperative data, and complications were retrieved from medical records.ResultsA total of 68 neonates underwent non-cardiac surgery under general anesthesia, of whom 48 received remifentanil. Infusion rate was 0.14 (0.04–0.35) mcg/kg/min (median, range). No intractable adverse events including postoperative apnea were detected.ConclusionRemifentanil is generally feasible to neonatal surgical population.
Highlights
The physiology of neonates and infants are different from that of adults
Remifentanil is generally feasible to neonatal surgical population
Infusion rate of remifentanil was titrated according to intraoperative hemodynamics
Summary
The physiology of neonates and infants are different from that of adults. Immaturity of their vital organ systems narrows the safety margin of perioperative management including anesthesia. Remifentanil has favorable characteristics for anesthesia in neonates such as rapid onset, potent analgesic effect, and rapid elimination. Despite existing literatures showing safety and effectiveness of remifentanil in children, especially in neonates [1,2,3,4,5,6], it has not gained a broad consensus among pediatric anesthesiologists. Physiology of neonates and infants is different from that of adults. Immaturity of their vital organ systems narrows a safety margin of perioperative management including anesthesia. Remifentanil was introduced into clinical practice since 1996, its application to neonatal anesthesia has not been validated yet
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