High-Dose Remifentanil Anesthesia With Minimal Sedation in Neonates: A Single-Center Retrospective Study.

Area of Science:

• Anesthesiology
• Neonatal Surgery
• Pharmacology

Background:

• Remifentanil offers rapid onset and elimination, theoretically aiding early emergence in anesthesia.
• High-dose remifentanil use in neonatal surgery is underreported, necessitating safety and efficacy evaluations.

Purpose of the Study:

• To describe high-dose remifentanil anesthesia techniques in neonates.
• To evaluate the safety outcomes of this anesthetic approach in neonatal surgical procedures.

Main Methods:

• Retrospective observational study of 15 neonatal abdominal surgeries (Jan 2016-Feb 2022).
• Defined high-dose remifentanil as ≥0.5 mcg/kg/min.
• Collected data on patient profiles, anesthetic drugs, and intra/post-operative adverse events.

Main Results:

• Average remifentanil infusion rate was 1.9 mcg/kg/min.
• Hypotension occurred in 13% of patients; no bradycardia was observed.
• Tracheal extubation averaged 16 minutes; 33% received naloxone, and 13% had post-extubation hypoxemia. No cardiorespiratory complications occurred post-OR.

Conclusions:

• High-dose remifentanil anesthesia can be safely employed in neonatal surgery without compromising hemodynamic stability.
• Respiratory depression remains a concern, warranting careful monitoring and management.
• Long-term outcome data are needed to fully understand the impact of this anesthetic strategy.