title: Remifentanil: applications in neonates.
abstract: Remifentanil is a synthetic opioid derivative that was introduced into clinical practice in the United States in 1996. The unique modification of its chemical structure to include a methyl-ester ring allows its hydrolysis by non-specific plasma and tissue esterases. This molecular configuration results in its rapid metabolism thereby providing a rapid onset, easy titration by continuous infusion, and a short context-sensitive half-life with rapid elimination. These principles are stable and consistent across all age groups regardless of the infusion characteristics. Owing to these pharmacokinetic characteristics, it is an effective agent in the neonatal population allowing the provision of intense analgesia and anesthesia with a rapid recovery profile in various clinical scenarios. Here, we review the pharmacokinetics of remifentanil in neonates, discuss its clinical applications including intraoperative administration for anesthetic care, unique applications for procedural sedation including endotracheal intubation, and its potential use for sedation in the Intensive Care Unit setting during mechanical ventilation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
authors.forename: Mineto
authors.initials: M
authors.lastname: Kamata
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. Joseph.Tobias@nationwidechildrens.org.|Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. Joseph.Tobias@nationwidechildrens.org.|Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. Joseph.Tobias@nationwidechildrens.org.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000494:pharmacology; D016292:Procedural Sedation; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology; D007231:Infant, Newborn; D010880:Piperidines / Q000009:adverse effects / Q000494:pharmacology; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil
keywords: Neonatal anesthesia; Remifentanil; Sedation