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Remifentanil Infusion (remifentanil + infusion)
Selected AbstractsExperience with remifentanil,sevoflurane balanced anesthesia for abdominal surgery in neonates and children less than 2 yearsPEDIATRIC ANESTHESIA, Issue 6 2008FABRICE MICHEL MD Summary Background:, Few data report remifentanil use in the neonatal population. We described here our experience with remifentanil,sevoflurane balanced anesthesia in neonates and children less than 2 years who underwent general anesthesia for abdominal surgery. Methods:, We retrospectively studied the pattern of remifentanil infusion associated with sevoflurane inhalation in preterm neonates (PTN; n = 18) (born before 37 weeks of gestation and <45 weeks of postmenstrual age), full-term neonates (FTN; n = 21) (born after 37 weeks of gestation and less than 29 days old) and older children up to 2 years (CUT; n = 24). We recorded heart rate (HR), mean arterial pressure (MAP), mean remifentanil dose and sevoflurane concentration before incision and at 5, 10, 20, 30, 45, 60, 90, and 105 min after incision. Results:, We observed that remifentanil doses used during surgery were lower in PTN than in both FTN and CUT and lower in FTN than in CUT. This was because of a progressive decrease in remifentanil dose during anesthesia in PTN and FTN. Conversely, remifentanil doses increased in CUT during anesthesia. Sevoflurane concentrations were higher in CUT group than in PTN and FTN groups. MAP and HR did not vary in the three groups during anesthesia. Conclusions:, Remifentanil,sevoflurane anesthesia can be used for general anesthesia in neonates. We observed that anesthetists used lower doses of remifantanil and lower concentrations of sevoflurane in neonates compared with the older children. [source] Effect-site concentration of propofol for reduction of remifentanil-induced coughANAESTHESIA, Issue 7 2010J. Y. Kim Summary This study examined the effectiveness of different propofol infusion target concentrations on cough suppression, during a target-controlled remifentanil infusion. Four hundred patients were randomly assigned to receive propofol target effect-site concentrations of 0, 3.0, 4.5, or 6.0 ,g.ml,1. When the propofol effect-site concentration reached the target, remifentanil was administered at a target effect-site concentration of 4.0 ng.ml,1. Episodes of cough were recorded over a 2-min period after remifentanil commencement, and graded as mild (1,2), moderate (3,4), or severe (5 or more). The overall incidence of cough was significantly decreased in by propofol 6.0 ,g.ml,1 compared with 0 or 3.0 ,g.ml,1 propofol (p < 0.001). The incidence of severe cough was significantly lower with propofol 6.0 ,g.ml,1 compared with 3.0 ,g.ml,1 (p = 0.03). A propofol target effect-site concentration of 6.0 ,g.ml,1 effectively suppressed remifentanil-induced cough when remifentanil was administrated at a target effect-site concentration of 4.0 ng.ml,1. [source] Awake tracheal intubation using the SensascopeÔ in 13 patients with an anticipated difficult airwayANAESTHESIA, Issue 5 2010R. Greif Summary We present the use of the SensaScopeÔ, an S-shaped rigid fibreoptic scope with a flexible distal end, in a series of 13 patients at high risk of, or known to have, a difficult intubation. Patients received conscious sedation with midazolam or fentanyl combined with a remifentanil infusion and topical lidocaine to the oral mucosa and to the trachea via a trans-cricoid injection. Spontaneous ventilation was maintained until confirmation of tracheal intubation. In all cases, tracheal intubation was achieved using the SensaScope. The median (IQR [range]) insertion time (measured from the time the facemask was taken away from the face until an end-expiratory CO2 reading was visible on the monitor) was 58 s (38,111 [28,300]s). In nine of the 13 cases, advancement of the SensaScope into the trachea was easy. Difficulties included a poor view associated with a bleeding diathesis and saliva, transient loss of spontaneous breathing, and difficulty in advancing the tracheal tube in a patient with unforeseen tracheal narrowing. A poor view in two patients was partially improved by a high continuous flow of oxygen. The SensaScope may be a valuable alternative to other rigid or flexible fibreoptic scopes for awake intubation of spontaneously breathing patients with a predicted difficult airway. [source] Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofolANAESTHESIA, Issue 2 2009M. K. Kim Summary The purpose of this study was to determine the effect-site concentration of remifentanil that would provide optimal conditions for successful laryngeal mask airway insertion during a target-controlled infusion (TCI) of propofol at 3.5 ,g.ml,1 without the use of neuromuscular blockade. Five minutes after propofol infusion, remifentanil was infused at a dose determined by a modified Dixon's up-and-down method. Five minutes after remifentanil infusion, the laryngeal mask was inserted. The effect-site concentration of remifentanil for successful laryngeal mask insertion in 50% of adults (EC50) was 3.04 (SD 0.49) ng.ml,1 during a TCI of 3.5 ,g.ml,1 propofol without neuromuscular blockade. From the probit analysis, the EC50 and EC95 of remifentanil were 2.84 ng.ml,1 (95% CI 2.09,3.57 ng.ml,1) and 3.79 ng.ml,1 (95% CI 3.26,9.25 ng.ml,1), respectively. [source] Remifentanil for INSURE in preterm infants: a pilot study for evaluation of efficacy and safety aspectsACTA PAEDIATRICA, Issue 9 2009L Welzing Abstract Aim:, To evaluate intubating conditions, extubation times and outcome in preterm infants receiving remifentanil as induction agent for the INSURE procedure. Methods:, In twenty-one preterm infants of 29 to 32 weeks gestation and signs of respiratory distress, we utilized remifentanil as induction agent for the INSURE procedure. Following intubation and surfactant application, the infants were mechanically ventilated until respiratory drive was judged to be satisfactory for continuing CPAP therapy. Intubating conditions were classified by our own scoring system by rating limb movements, coughing and breathing. Heart rate, blood pressure and oxygen saturation were recorded during the entire INSURE procedure. Results:, Remifentanil provided excellent or good intubating conditions in all patients. We observed no serious side effects after remifentanil infusion, in particular, no thorax rigidity, clinically significant bradycardia or arterial hypotension. Average extubation time after surfactant administration was 16.9 min (1,45 min); none of the infants had to be reintubated. Following extubation, the infants required only 3.3 days (1,8 days) of CPAP therapy. None exhibited serious complications of prematurity like periventricular leucomalacia, intraventricular haemorrhage >I°, necrotizing enterocolitis or retinopathy. Conclusion:, In this pilot study, INSURE with remifentanil was associated with good intubating conditions and early extubation resulting in an excellent neonatal outcome. [source] Remifentanil analgosedation in preterm newborns during mechanical ventilationACTA PAEDIATRICA, Issue 7 2009Carmen Giannantonio Abstract Aim:, To assess efficacy of remifentanil in preterm newborns during mechanical ventilation. Methods:, Remifentanil was administered by continuous intravenous infusion to provide analgesia and sedation in 48 preterm infants who developed respiratory distress and required mechanical ventilation. We examined the doses needed to provide adequate analgesia, extubation time after the discontinuation of opioid infusion, the presence of side effects and safety of the use. Results:, Remifentanil provided adequate analgesia, with a significant reduction of NIPS and COMFORT score since 1 h after starting the infusion of remifentanil. The drug was initially administered at a dose of 0.075 ,g/kg/min, but in 73% of newborns the latter had to be increased; at a dose of 0.094 ± 0.03 (mean ± standard deviation) ,g/kg/min, 97% of the newborns received adequate analgesia and sedation. The time elapsed between the discontinuation of remifentanil infusion and extubation was 36 ± 12 min. Treatment was started between the 1st and the 17th day of life. The mean duration of therapy was 5.9 ± 5.7 days. No side effects on the respiratory or cardiovascular system were observed. Conclusion:, Remifentanil is a manageable and effective opioid in the newborn undergoing mechanical ventilation, though randomized controlled trials and information about long-term outcomes are necessary. [source] | ||||||||||