piperidines and Arachnoid-Cysts

Patient-controlled analgesia (PCA) using intravenous opioids is increasing in popularity for children aged 5 years and over. To our knowledge there are no reports on the use of PCA in children with remifentanil in the postoperative period. We report successful use of remifentanil for intravenous (IV) PCA in a child scheduled for suprasellar arachnoid cystectomy with Axenfeld-Rieger syndrome who needed good postoperative analgesia because of accompanying serious problems.

Topics: Abnormalities, Multiple; Analgesia, Patient-Controlled; Analgesics, Opioid; Arachnoid Cysts; Child; Eye Diseases; Genes, Dominant; Heart Diseases; Humans; Infusions, Intravenous; Male; Monitoring, Intraoperative; Pain Measurement; Pain, Postoperative; Piperidines; Remifentanil; Syndrome

We describe a 73-yr-old woman anaesthetized for a laminectomy. She suffered from hepatic failure with mild encephalopathy complicated by several exacerbations associated with sedative and opioid therapy. The challenge for anaesthesia management was to provide adequate analgesia and avoid causing hepatic encephalopathy during and after the surgery. We used remifentanil to provide intraoperative and postoperative analgesia, because it has a short duration of action and does not require hepatic metabolism. We closely monitored the respiratory and the neurological status throughout the administration and conclude that remifentanil can provide perioperative analgesia in patients at risk of developing hepatic encephalopathy.

Topics: Aged; Analgesia; Analgesics, Opioid; Arachnoid Cysts; Chronic Disease; Contraindications; Female; Humans; Laminectomy; Liver Failure; Pain, Postoperative; Piperidines; Remifentanil