{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:09:42Z","timestamp":1790168982169,"version":"4.1.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,2]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n Intraoperative infusion of opioids has been associated with increased postoperative pain and analgesic requirements, but the development of tolerance in young children is less clear. This prospective, randomized, double-blinded study was designed to test the hypothesis that the intraoperative administration of remifentanil results in postoperative opioid tolerance in a dose-related manner in young children.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n We enrolled 60 children (aged 1\u20135 yr) who were undergoing elective laparoscopic ureteroneocystostomy. Patients were randomized and received an intraoperative infusion of 0, 0.3, 0.6, or 0.9 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n remifentanil. Postoperative pain was managed by a parent\/nurse-controlled analgesia pump using fentanyl. The primary outcome included the total fentanyl consumptions at 24 and 48 h postsurgery. Secondary outcomes were the postoperative pain scores and adverse effects.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The children who received 0.6 and 0.9 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n remifentanil required more postoperative fentanyl than the children who received saline or 0.3 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n remifentanil (all\n P<\/jats:italic>\n < 0.001) for 24 h after surgery. The children who received 0.3\u20130.9 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n intraoperative remifentanil reported higher pain scores at 1 h after surgery than the children who received saline (\n P<\/jats:italic>\n = 0.002,\n P<\/jats:italic>\n = 0.023, and\n P<\/jats:italic>\n = 0.006, respectively). No significant intergroup differences in recovery variables were observed, but vomiting was more frequent in the 0.9 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n remifentanil group than in the other groups (\n P<\/jats:italic>\n = 0.027).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n The intraoperative use of 0.3 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n remifentanil for approximately 3 h (range: 140\u2013265 min) did not induce acute tolerance, but the administration of 0.6 and 0.9 \u00b5g\u00b7kg\n \u22121<\/jats:sup>\n \u00b7min\n \u22121<\/jats:sup>\n remifentanil to young children resulted in acute tolerance for 24 h after surgery in an apparently dose-related manner.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/aln.0b013e31827bd108","type":"journal-article","created":{"date-parts":[[2012,12,14]],"date-time":"2012-12-14T06:26:17Z","timestamp":1355466377000},"page":"337-343","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":41,"title":["Intraoperative Infusion of 0.6\u20130.9 \u00b5g \u00b7 kg\u22121 \u00b7 min\u22121 Remifentanil Induces Acute Tolerance in Young Children after Laparoscopic Ureteroneocystostomy"],"prefix":"10.1097","volume":"118","author":[{"given":"Sung-Hoon","family":"Kim","sequence":"first","affiliation":[{"name":"Fellow"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Instructor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyungseok","family":"Seo","sequence":"additional","affiliation":[{"name":"Clinical Fellow"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In-Gyu","family":"Lee","sequence":"additional","affiliation":[{"name":"Resident"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Yeon","family":"Hong","sequence":"additional","affiliation":[{"name":"Professor, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai-Hyun","family":"Hwang","sequence":"additional","affiliation":[{"name":"Head of Department, Department of Anesthesiology, Isan Woman\u2019s Clinic, Goyang, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250520","first-page":"301","article-title":"Remifentanil in paediatric anaesthetic practice.","volume":"118","year":"2009","journal-title":"Anaesthesia"},{"key":"R2-20250520","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/j.1460-9592.2009.03241.x","article-title":"Remifentanil in children.","volume":"20","year":"2010","journal-title":"Paediatr Anaesth"},{"key":"R3-20250520","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/bja\/76.3.341","article-title":"Remifentanil\u2013an opioid for the 21st century.","volume":"76","year":"1996","journal-title":"Br J Anaesth"},{"key":"R4-20250520","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/01.aco.0000084479.59960.3f","article-title":"Remifentanil: An update.","volume":"16","year":"2003","journal-title":"Curr Opin Anaesthesiol"},{"key":"R5-20250520","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1097\/00000542-200008000-00019","article-title":"Acute opioid tolerance: Intraoperative remifentanil increases postoperative pain and morphine requirement.","volume":"93","year":"2000","journal-title":"Anesthesiology"},{"key":"R6-20250520","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S0304-3959(03)00276-8","article-title":"Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal.","volume":"106","year":"2003","journal-title":"Pain"},{"key":"R7-20250520","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00000542-200507000-00022","article-title":"Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine.","volume":"103","year":"2005","journal-title":"Anesthesiology"},{"key":"R8-20250520","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/AJP.0b013e31816b2f43","article-title":"Opioid-induced hyperalgesia in humans: Molecular mechanisms and clinical considerations.","volume":"24","year":"2008","journal-title":"Clin J Pain"},{"key":"R9-20250520","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1213\/00000539-200004000-00017","article-title":"A randomized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients.","volume":"90","year":"2000","journal-title":"Anesth Analg"},{"key":"R10-20250520","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1111\/j.1460-9592.2006.01999.x","article-title":"Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants.","volume":"17","year":"2007","journal-title":"Paediatr Anaesth"},{"key":"R11-20250520","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/j.1460-9592.2007.02218.x","article-title":"Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting.","volume":"17","year":"2007","journal-title":"Paediatr Anaesth"},{"key":"R12-20250520","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0196-0644(03)00721-2","article-title":"Bispectral index monitoring quantifies depth of sedation during emergency department procedural sedation and analgesia in children.","volume":"43","year":"2004","journal-title":"Ann Emerg Med"},{"key":"R13-20250520","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/ALN.0b013e3181e2c34b","article-title":"Fentanyl-sparing effect of acetaminophen as a mixture of fentanyl in intravenous parent-\/nurse-controlled analgesia after pediatric ureteroneocystostomy.","volume":"113","year":"2010","journal-title":"Anesthesiology"},{"key":"R14-20250520","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1097\/00000539-200112000-00008","article-title":"Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures.","volume":"93","year":"2001","journal-title":"Anesth Analg"},{"key":"R15-20250520","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1213\/01.ane.0000216036.95705.c2","article-title":"Development of acute opioid tolerance during infusion of remifentanil for pediatric scoliosis surgery.","volume":"102","year":"2006","journal-title":"Anesth Analg"},{"key":"R16-20250520","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1046\/j.1460-9592.2003.01102.x","article-title":"Remifentanil infusion for cleft palate surgery in young infants.","volume":"13","year":"2003","journal-title":"Paediatr Anaesth"},{"key":"R17-20250520","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/bja\/82.1.112","article-title":"Surgical pain attenuates acute morphine tolerance in rats.","volume":"82","year":"1999","journal-title":"Br J Anaesth"},{"key":"R18-20250520","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/bja\/81.1.12","article-title":"Molecular mechanisms of opioid receptor signal transduction.","volume":"81","year":"1998","journal-title":"Br J Anaesth"},{"key":"R19-20250520","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1213\/00000539-200007000-00021","article-title":"Acute tolerance to continuously infused alfentanil: The role of cholecystokinin and N-methyl-D-aspartate-nitric oxide systems.","volume":"91","year":"2000","journal-title":"Anesth Analg"},{"key":"R20-20250520","doi-asserted-by":"crossref","first-page":"8578","DOI":"10.1523\/JNEUROSCI.20-23-08578.2000","article-title":"Postsynaptic signaling via the [mu]-opioid receptor: Responses of dorsal horn neurons to exogenous opioids and noxious stimulation.","volume":"20","year":"2000","journal-title":"J Neurosci"},{"key":"R21-20250520","doi-asserted-by":"crossref","first-page":"6747","DOI":"10.1523\/JNEUROSCI.22-15-06747.2002","article-title":"Sustained morphine exposure induces a spinal dynorphin-dependent enhancement of excitatory transmitter release from primary afferent fibers.","volume":"22","year":"2002","journal-title":"J Neurosci"},{"key":"R22-20250520","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1046\/j.1440-1681.2001.03418.x","article-title":"Acute opioid receptor desensitization and tolerance: Is there a link?","volume":"28","year":"2001","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"R23-20250520","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1046\/j.1460-9592.1999.00419.x","article-title":"Remifentanil infusion for major abdominal surgery in small infants.","volume":"9","year":"1999","journal-title":"Paediatr Anaesth"},{"key":"R24-20250520","first-page":"840","article-title":"Induction and recovery characteristics and hemodynamic responses to sevoflurane and halothane in children.","volume":"79","year":"1994","journal-title":"Anesth Analg"},{"key":"R25-20250520","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1213\/00000539-200009000-00014","article-title":"The safety and efficacy of parent-\/nurse-controlled analgesia in patients less than six years of age.","volume":"91","year":"2000","journal-title":"Anesth Analg"},{"key":"R26-20250520","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3346\/jkms.2008.23.1.122","article-title":"Parent-controlled analgesia in children undergoing cleft palate repair.","volume":"23","year":"2008","journal-title":"J Korean Med Sci"},{"key":"R27-20250520","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1097\/00000542-199711000-00012","article-title":"Subjective, psychomotor, cognitive, and analgesic effects of subanesthetic concentrations of sevoflurane and nitrous oxide.","volume":"87","year":"1997","journal-title":"Anesthesiology"},{"key":"R28-20250520","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/bja\/75.1.55","article-title":"Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by experimentally induced pain.","volume":"75","year":"1995","journal-title":"Br J Anaesth"},{"key":"R29-20250520","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1093\/bja\/70.6.684","article-title":"Alterations in pain threshold and psychomotor response associated with subanaesthetic concentrations of inhalation anaesthetics in humans.","volume":"70","year":"1993","journal-title":"Br J Anaesth"}],"container-title":["Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/pubs.asahq.org\/anesthesiology\/article-pdf\/118\/2\/337\/491241\/20130200_0-00018.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.lww.com\/00000542-201302000-00014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T07:24:58Z","timestamp":1747725898000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00000542-201302000-00014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,2]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2013]]}},"URL":"https:\/\/doi.org\/10.1097\/aln.0b013e31827bd108","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.717969681.793469253","asserted-by":"object"}]},"ISSN":["0003-3022"],"issn-type":[{"value":"0003-3022","type":"print"}],"subject":[],"published":{"date-parts":[[2013,2]]}}}