Appropriate Dose of Remifentanil for the Prevention of Emergence Agitation after Total Intravenous Anesthesia (TIVA) in Pediatric Patients Undergoing Tonsillectomy

ABSTRACT

BACKGROUND: Pediatric tonsillectomy may be associated with a high incidence of emergence agitation. The aim of this study was to determine the appropriate dose of remifentanil continuously administered in the postanesthetic care unit (PACU) to reduce the incidence of emergence agitation and side effects after total intravenous anesthesia (TIVA). METHODS: Sixty children aged from 4 to 12 years undergoing tonsillectomy were randomly assigned to 3 groups. Anesthesia was induced with 1.5 mg/kg of propofol, 1microg/kg of remifentanil and was maintained with continuous infusion of propofol 100microg/kg/min, remifentanil 0.25microg/kg/min. At the end of surgery, each group received 0.025 (group 1), 0.05 (group 2), or 0.1 (group 3)microg/kg/min of remifentanil, respectively and the infusion was discontinued at 10 min before PACU discharge. Duration of anesthesia and emergence time were evaluated at the operating room. Agitation score, the time of stay in PACU and postoperative side effects were evaluated at the PACU. RESULTS: The emergence time and the time of stay in PACU were prolonged in the group 3 compared to the other groups (P < 0.05). The Group 2 and 3 had lower agitation score in comparison with that of the group 1 in the PACU (P < 0.05). CONCLUSIONS: For reducing emergence agitation after TIVA, we recommend infusion dose of remifentanil 0.05microg/kg/min.