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.

中文翻译：

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胎儿、早产儿和足月新生儿接触瑞芬太尼：功效和安全性的系统评价

背景

由于其药效学特性，特别是起效快且作用持续时间短，瑞芬太尼在产科麻醉以及新生儿科中的使用可能会越来越多。

客观的

我们进行了系统评价，以评估瑞芬太尼对早产儿和足月新生儿的疗效和安全性。感兴趣的结果是胎儿暴露后的新生儿适应情况；侵入性手术期间新生儿疼痛、痛苦和不适的控制；以及瑞芬太尼输注引起的血流动力学效应或呼吸抑制的发生。

方法

鉴于不同的使用环境，我们将这项工作分为三个部分：（A）使用瑞芬太尼进行分娩或剖腹产，并在出生前暴露胎儿，（B）短暂用于新生儿手术镇痛，以及（C）长期用于新生儿镇静/镇痛。书目检索是根据2000年1月1日至2022年12月31日期间使用电子医学数据库（DATABASE、Cochrane Library、PubMed 和 EMBASE）的关键词进行的。

结果

共收录 22 篇文章（A 部分 10 篇，B 部分 5 篇，C 部分 7 篇）。保留前瞻性、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。当瑞芬太尼用于镇静/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，程序简单。胸壁僵硬似乎是一种常见的副作用，但这可以通过缓慢且连续的输注以及使用最小有效剂量来控制。

结论

瑞芬太尼似乎在短期内对早产儿和足月新生儿有效且安全。然而，其安全性因胸壁僵硬的风险而受到损害。它应该在适当的新生儿科室中使用，并在能够监测其副作用的医生在场的情况下使用。据我们所知，长期结果尚未得到评估。