Use of remifentanil in general anesthesia for neonatal non-cardiac surgery: a case series

OBJECTIVE: This case series aimed to summarize our experience in usage of remifentanil in neonates undergoing non-cardiac surgery. BACKGROUND: Physiology of neonates and infants is different from that of adults. Immaturity of their vital organ systems narrows a safety margin of perioperative management including anesthesia. Remifentanil has favorable characteristics for pediatrics such as short duration of action and rapid elimination. Although remifentanil was introduced into clinical practice since 1996, its application to neonatal anesthesia has not been validated yet. METHODS: This is a 14-month retrospective case series of neonates receiving remifentanil during non-cardiac surgery at a tertiary care pediatric hospital in Japan. Patients’ characteristics, intraoperative data, and complications were retrieved from medical records. RESULTS: A total of 68 neonates underwent non-cardiac surgery under general anesthesia, of whom 48 received remifentanil. Infusion rate was 0.14 (0.04–0.35) mcg/kg/min (median, range). No intractable adverse events including postoperative apnea were detected. CONCLUSION: Remifentanil is generally feasible to neonatal surgical population.