Comparison of Remifentanil-Propofol and Remifentanil-Sevoflurane Anesthesia for Pediatric Tonsillectomy

BACKGROUND: This study compared the hemodynamic response and recovery profile of remifentanil-sevoflurane anesthesia for a pediatric tonsillectomy with that of remifentanil-propofol anesthesia. METHODS: Fifty healthy children (4-10 yr) undergoing a tonsillectomy were randomly assigned to one of two groups. Anesthesia was induced with remifentanil 1 mcg/kg over 1 min, propofol 2 mg/kg, and rocuronium 0.8 mg/kg. Anesthesia was maintained with remifentanil 0.25 mcg/kg/min and propofol 6 mg/kg/h, or remifentanil 0.25 mcg/kg/min and sevoflurane 1.0 vol%. The propofol and sevoflurane dose was kept unchanged, and remifentanil was titrated according to the hemodynamic response. The perioperative hemodynamics, recovery time, and side effects were assessed. RESULTS: Remifentanil-based anesthesia with propofol or sevoflurane resulted in stable hemodynamics, but sevoflurane was associated with a significantly lower systolic blood pressure. The recovery times were similar for spontaneous ventilation, extubation, eye opening, orientation, and full recovery in both groups. The incidence of side effects was similar in both groups. CONCLUSIONS: Remifentanil/sevoflurane is as equally effective as remifentanil/propofol in pediatric patients. The hemodynamic stability is appropriate and the recovery from anesthesia is rapid.

Comparison of Total Intravenous Anesthesia between Two Dosing Regimens of Remifentanil and Propofol

BACKGROUND: More remifentanil and less propofol may speed up the early recovery from anesthesia. This study evaluated the hemodynamic response and recovery profile of high-dose remifentanil/lowdose propofol anesthesia, compared with low-dose remifentanil/highdose propofol anesthesia for lower abdominal surgery. METHODS: Sixty women undergoing lower abdominal surgery were randomly assigned to either groups H or L. Anesthesia was maintained with remifentanil 0.5 micro/kg/min and propofol 4 mg/kg/h in group H, or with remifentanil 0.25 micro/kg/min and propofol 8 mg/kg/h in group L. The heart rate, blood pressure, and EEG bispectral index (BIS) score were recorded. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. RESULTS: In both groups, the heart rate and systolic blood pressure were decreased over time compared with the preanesthetic baseline values (P < 0.05) but there were no differences between the two groups. The frequency of hemodynamic events (hypertension, hypotension, and bradycardia) and their rescue drugs were similar in the two groups. The BIS scores were lower during anesthesia in group L than in group H (P < 0.05). The time to spontaneous ventilation, eye opening on verbal command, extubation, orientation, and full recovery were faster in group H than in group L (P < 0.05). The incidences of side effects were similar in both groups. CONCLUSIONS: In lower abdominal surgery, high-dose remifentanil/ low-dose propofol anesthesia offers faster recovery than low-dose remifentanil/high-dose propofol anesthesia. However, there were no differences in the hemodynamic changes and side effects between the groups.