Fetal, Preterm, and Term Neonate Exposure to Remifentanil: A Systematic Review of Efficacy and Safety.

IF 3.4 3区医学 Q1 PEDIATRICS

Pediatric Drugs Pub Date : 2023-09-01 DOI:10.1007/s40272-023-00583-w

Arielle Maroni, Marie-Stéphanie Aubelle, Clément Chollat

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引用次数: 1

Abstract

Background: Owing to its pharmacodynamic properties, especially the rapid onset and short duration of its action, the use of remifentanil in obstetric anesthesia, as well as in neonatology, might be increasingly used.

Objective: We conducted a systematic review to assess the efficacy and safety of remifentanil in preterm and term neonates. Outcomes of interest were neonatal adaptation after fetal exposure; neonatal pain, distress, and discomfort control during invasive procedures; and the occurrence of hemodynamic effects or respiratory depression induced by remifentanil infusion.

Methods: Given the different contexts of use, we have organized this work into three parts: (A) use of remifentanil for labor or cesarean section, with exposure of the fetus before birth, (B) brief use for neonatal procedural analgesia, and (C) prolonged use for sedation/analgesia of neonates. The bibliographic search was conducted based on keywords using electronic medical databases (DATABASE, Cochrane Library, PubMed, and EMBASE) from 1 January 2000 until 31 December 2022.

Results: Twenty-two articles were included (10 in part A, 5 in part B and 7 in part C). Prospective, controlled, randomized, blinded, and intention-to-treat trials were retained. Neonates were well adapted after exposure to remifentanil in the fetal period. Pain, stress, and discomfort were controlled during a brief or prolonged invasive procedure when remifentanil was used for sedation/analgesia. The physiological parameters were stable and the procedures were straightforward. Chest wall rigidity appeared to be a common side effect, but this can be managed by slow and continuous infusion and by using the minimum effective dose.

Conclusions: Remifentanil appears to be effective and safe in the short term in preterm and full-term neonates. However, its safety is compromised by the risk of chest wall rigidity. It should be used in appropriate neonatal units and in the presence of physicians able to monitor its side effects. Long-term outcomes have not been evaluated, to our knowledge.

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胎儿，早产儿和足月新生儿暴露于瑞芬太尼:有效性和安全性的系统评价。

背景:由于其药效学特性，特别是其起效快、持续时间短，瑞芬太尼在产科麻醉和新生儿麻醉中的应用可能会越来越多。目的:我们对瑞芬太尼用于早产儿和足月新生儿的有效性和安全性进行了系统评价。关注的结果是胎儿暴露后的新生儿适应;侵入性手术过程中新生儿疼痛、窘迫和不适的控制;输液瑞芬太尼引起的血流动力学影响或呼吸抑制的发生。方法:考虑到不同的使用环境，我们将这项工作分为三个部分:(A)在分娩或剖宫产中使用瑞芬太尼，在出生前暴露胎儿，(B)短暂用于新生儿程序镇痛，(C)长期用于新生儿镇静/镇痛。从2000年1月1日至2022年12月31日，使用电子医学数据库(DATABASE、Cochrane Library、PubMed和EMBASE)进行了基于关键词的书目检索。结果:纳入了22篇文章(A部分10篇，B部分5篇，C部分7篇)。保留了前瞻性、对照、随机、盲法和意向治疗试验。新生儿在胎儿期接触瑞芬太尼后适应良好。当使用瑞芬太尼镇静/镇痛时，疼痛、压力和不适在短暂或长时间的侵入性手术中得到控制。生理参数稳定，操作简单。胸壁僵硬似乎是一个常见的副作用，但这可以通过缓慢持续输注和使用最小有效剂量来控制。结论:瑞芬太尼对早产儿和足月新生儿短期内安全有效。然而，其安全性受到胸壁刚性风险的影响。它应该在适当的新生儿病房使用，并有能够监测其副作用的医生在场。据我们所知，长期结果尚未得到评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Drugs PEDIATRICS-PHARMACOLOGY & PHARMACY

CiteScore

7.20

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Pediatric Drugs promotes the optimization and advancement of all aspects of pharmacotherapy for healthcare professionals interested in pediatric drug therapy (including vaccines). The program of review and original research articles provides healthcare decision makers with clinically applicable knowledge on issues relevant to drug therapy in all areas of neonatology and the care of children and adolescents. The Journal includes: -overviews of contentious or emerging issues. -comprehensive narrative reviews of topics relating to the effective and safe management of drug therapy through all stages of pediatric development. -practical reviews covering optimum drug management of specific clinical situations. -systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. -Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in the pediatric population. -original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Pediatric Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.