Safe Sedation and Analgesia Management With Remifentanil in Pediatric ICU Patients: A Report of Two Cases

Although remifentanil (RF) is not approved for use in the ICU for children, its short half-life and titratability may provide advantages in children requiring high doses of sedatives and analgesics during prolonged mechanical ventilation. This report presents two pediatric cases in which RF was administered for sedation and analgesia, enabling successful extubation without adverse effects. In Case 1, a four-year-old girl with multiple atypical teratoid rhabdoid tumors required mechanical ventilation due to impaired consciousness. RF was initiated at 0.22 μg/kg/min and titrated up to 0.48 μg/kg/min on the day before extubation, allowing the reduction of other sedatives. She received RF for a total of 16 hours (5.66 mg) before it was discontinued, and extubation was successfully performed 70 minutes later. In Case 2, a three-year-old girl with a severe neck abscess required prolonged intubation following surgical drainage. RF was started at 0.1 μg/kg/min and increased to 0.2 μg/kg/min on the day before extubation, facilitating the tapering of other sedatives. She received RF for a total of 23 hours (4.4 mg) before discontinuation, and extubation was successfully performed 25 minutes later. Throughout RF administration, hemodynamic stability was maintained, with no occurrences of hypotension, bradycardia, desaturation, hepatic or renal dysfunction, muscle rigidity, or hyperalgesia. No additional catecholamines were required, and no signs of withdrawal symptoms were observed. These findings suggest that RF may be a safe and effective option for sedation and analgesia in pediatric patients undergoing prolonged mechanical ventilation.