Remifentanil analgosedation in preterm newborns during mechanical ventilation.
OBJECTIVE
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 microg/kg/min, but in 73% of newborns the latter had to be increased; at a dose of 0.094 +/- 0.03 (mean +/- standard deviation) microg/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.


CONCLUSIONS
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.
Giannantonio
Carmen
C
Department of Paediatrics, Division of Neonatology, Sacro Cuore Catholic University, Rome, Italy.
Sammartino
Maria
M
Valente
Elisabetta
E
Cota
Francesco
F
Fioretti
Maria
M
Papacci
Patrizia
P
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D015999:Multivariate Analysis; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011014:Pneumonia / Q000628:therapy; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy*; D015656:Respiratory Mechanics / Q000187:drug effects*
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil