Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low-dose remifentanil
Paediatric Anaesthesia, 07/05/2012
Shen X et al. – Low–dose remifentanil in combination with sevoflurane provided rapid recovery and was safe for deep tracheal extubation in deep anesthesia in pediatric patients.Methods
- The authors randomly allocated 50 pediatric patients undergoing elective electronic cochlear implantation to groups either receiving sevoflurane (Group S, n=25), or sevoflurane plus low–dose remifentanil (Group SR, n=25), during extubation from anesthesia.
- In Group S, subjects were tracheally extubated while breathing 1.3 times the minimal effective concentration of sevoflurane.
- In Group SR, subjects were tracheally extubated while breathing 1.0 times the minimal effective concentration of sevoflurane with 0.02–0.05µg.kg–1 per min remifentanil.
- Recovery characteristics and airway complications were noted.
- There was no significant difference in age, weight, sex, and duration of anesthesia.
- The average remifentanil rate was 0.036µg.kg–1 per min, and compared with Group S, patients in Group SR had a lower respiratory rate (17.3 vs 20.2 per minute, P<0.05) and a higher ETCO2 (52.3 vs 49.4mmHg, P<0.05).
- Oral airway usage was also less frequent in Group SR (44% vs 16%, P<0.01).
- Additionally, the time from extubation to spontaneous eye opening was shorter in Group SR (10.9min vs 19.6min, P<0.01).
- Finally, six patients in Group S and five patients in Group SR had a pediatric anesthesia emergence delirium score >10.