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  • Finally, results from this large data sharing collaborative describing the practice of pediatric critical care are included for the purpose of pediatric intensive care units practice benchmarks. ""Remifentanil has gained the confidence of anesthesiologists and has given a real opportunity to change the way anesthesia is given. It can be considered the ideal opioid despite many obstacles to pediatric use: the condition of ��off-label��, the lack of wide randomized clinical trials, and the fear of adverse events because of its high potency. Experiences in the field with this opioid over the years encouraged its use. Use has been associated with N20 and volatile agents for general anesthesia and with propofol for total intravenous anesthesia (TIVA). It seems very useful for sedation inside and outside the operating room and in intensive care for both short painful procedures and synchronization selleck kinase inhibitor with mechanical ventilation. However, its unique selleck chemical pharmacokinetic characteristics causing rapid onset and offset of effect appear unchanged in small children and even in premature neonates and need to be really confirmed by further pharmacokinetic studies. Moreover, the real risks of tolerance and hyperalgesia should be evaluated in the pediatric population. In this review, we go through the newer aspects of this versatile drug that has been proposed as ��the pediatric anesthetist��s opiate��. Remifentanil can be considered the best answer to the search for the ideal opioid because of its unique pharmacokinetic characteristics, different from any other opioid (1�C4). The RhoC ester-linkage makes the compound susceptible to metabolism by nonspecific plasma and tissues esterases, independent from hepatic and renal function (5,6), and it can be safely used even in anhepatic period of liver transplantation or when facing with failure or immaturity of most parenchyma (7,8). Pharmacokinetics (PK) does not change in patients who are deficient in pseudocholinesterase activity, showing that it is not a good substrate for butyrylcholinesterase (9). Remifentanil has a rapid onset, small volume of distribution (Vd), rapid clearance (CL), and a brief half-time (1.0�C1.5?min) for equilibration (t?Ke0) between plasma and the effect compartment (10). Its extremely short context-sensitive half-life (3�C5?min) and the rapid recovery from drug effect are the hallmarks of remifentanil��s unicity. Davis et?al. (11) investigated PK parameters of remifentanil in infants <2?months. Ross et?al. (12) confirmed these PK parameters estimates and found that CL and Vd appeared higher compared with older age groups (2?months�C18?years). However, she found that t1/2�� does not change with age (Table?1). Tod et?al. (13) identified size, age, and organ function as the three major contributors to pediatric PK variability.</div>

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