piperidines and Infant--Newborn--Diseases

Short-acting opioids like remifentanil are suspected of an increased risk for tolerance, withdrawal and opioid-induced hyperalgesia (OIH). These potential adverse effects have never been investigated in neonates.. To compare remifentanil and fentanyl concerning the incidence of tolerance, withdrawal and OIH.. 23 mechanically ventilated infants received up to 96 h either a remifentanil- or fentanyl-based analgesia and sedation regimen with low-dose midazolam. We compared the required opioid doses and the number of opioid dose adjustments. Following extubation, withdrawal symptoms were assessed by a modification of the Finnegan score. OIH was evaluated by the CHIPPS scale and by testing the threshold of the flexion withdrawal reflex with calibrated von Frey filaments.. Remifentanil had to be increased by 24% and fentanyl by 47% to keep the infants adequately sedated during mechanical ventilation. Following extubation, infants revealed no pronounced opioid withdrawal and low average Finnegan scores in both groups. Only 1 infant of the fentanyl group and 1 infant of the remifentanil group required methadone for treatment of withdrawal symptoms. Infants also revealed no signs of OIH and low CHIPPS scores in both groups. The median threshold of the flexion withdrawal reflex was 4.5 g (IQR = 2.3) in the fentanyl group and 2.7 g (IQR = 3.3) in the remifentanil group (p = 0.312), which is within the physiologic range of healthy infants.. Remifentanil does not seem to be associated with an increased risk for tolerance, withdrawal or OIH.

Topics: Analgesia; Analgesics, Opioid; Drug Tolerance; Fentanyl; Gestational Age; Humans; Hyperalgesia; Hypnotics and Sedatives; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Piperidines; Remifentanil; Respiration, Artificial; Substance Withdrawal Syndrome

General anesthesia may be required for placenta accreta cesarean delivery. Intrauterine fetal anesthetic exposure should be minimized to avoid neonatal respiratory depression; opioids are often delayed until post-delivery.. In this observational study, we compared neonatal outcome using pre-delivery remifentanil versus post-delivery (deferred) opioids for placenta accreta cesarean delivery. Choice of anesthesia was discretionary. The primary outcome was Apgar score at 5 min comparing women who received pre-delivery remifentanil versus deferred opioid administration. We recorded maternal/obstetric characteristics, surgical characteristics, maternal hemodynamic data, neonatal outcomes: Apgar scores, umbilical vein pH and respiratory interventions at birth.. Between February 2007 and April 2014 we identified 40 general anesthesia placenta accreta cesarean deliveries. The remifentanil dose rate ranged from 0.06 to 0.46 mcg kg(-1 )min(-1). Obstetric and maternal characteristics were similar. Neonatal Apgar, umbilical pH and respiratory intervention outcomes were similar in both groups; Apgar scores median (interquartile range IQR [range]) at 5 min were 9 (8-10) for pre-delivery remifentanil versus 9 (9-10) for deferred opioid administration, p = 0.18.. We did not observe a significant effect on neonatal Apgar scores at 1 and 5 min, or respiratory interventions at birth when remifentanil infusion was administered pre-delivery.

Topics: Adult; Analgesics, Opioid; Apgar Score; Cesarean Section; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Piperidines; Placenta Accreta; Pregnancy; Prospective Studies; Remifentanil

Topics: Adolescent; Anti-Arrhythmia Agents; Benzeneacetamides; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Piperidines; Wolff-Parkinson-White Syndrome

Topics: Digestive System Abnormalities; Duodenum; Esophagus; Female; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Absorption; Intestinal Obstruction; Malabsorption Syndromes; Male; Megacolon; Piperidines; Postoperative Complications