Early awakening and extubation with remifentanil in ventilated premature neonates.
BACKGROUND
Morphine is one of the most commonly used drugs for sedation and analgesia during mechanical ventilation, but its pharmacological profile has limitations, such as prolonged duration of action, especially in premature neonates. Because of its very short context-sensitive half-time, remifentanil has rapid onset and quickly decreases in plasma concentration after interrupting administration. The aim of the present study was to compare a continuous infusion of remifentanil and morphine during mechanical ventilation of premature neonates with respiratory distress syndrome (RDS).


METHODS
Twenty premature neonates (28-34 weeks) with RDS were randomized in a prospective double-blinded study to receive either a continuous infusion of morphine (n = 10) or remifentanil (n = 10) for mechanical ventilation. The length of time to awaken and extubate the neonate after interrupting opioid administration was recorded. We also recorded stress (COMFORT scale), pain response [Neonatal Infant Pain Scale (NIPS)], hemodynamic and ventilatory variables as well as adverse effects secondary to infusion of the specific opioid.


RESULTS
After terminating infusion, 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. Both groups produced good quality sedation and analgesia as evaluated by the NIPS and COMFORT scores. No major side effects were observed.


CONCLUSIONS
Our results show an interesting potential for the use of remifentanil in premature neonates. Remifentanil allowed an adequate level of sedation and analgesia as well as rapid recovery after discontinuation. However, further properly designed clinical trials are needed before it can be generally recommended.
e Silva
Yerkes Pereira
YP
Department of Anesthesiology and Neonatology, Lifecenter Hospital, Belo Horizonte, Minas Gerais, Brazil. yerkesps@uol.com.br
Gomez
Renato Santiago
RS
Marcatto
Juliana de Oliveira
Jde O
Maximo
Thadeu Alves
TA
Barbosa
Rosilu Ferreira
RF
e Silva
Ana Cristina Simões
AC
D000328:Adult; D000701:Analgesics, Opioid; D000762:Anesthesia Recovery Period; D016292:Procedural Sedation; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006993:Hypnotics and Sedatives; D007231:Infant, Newborn; D007234:Infant, Premature; D007262:Infusions, Intravenous; D008297:Male; D008423:Maternal Age; D009020:Morphine; D010880:Piperidines; D000077208:Remifentanil; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D013997:Time Factors
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil