Propofol/Remifentanil TIVA provides superior recovery parameters over Propofol / Sevoflurane anesthesia in children

ABSTRACT

This study aimed to evaluate the applicability of remifentanil-based anesthesia in comparison to sevoflurane-based anesthesia in 60 children assigned to undergo lower abdominal extra-intestinal surgical procedures, Patients were randomly allocated into two equal groups Propofol/Remifentanil [PR group] or Propofol/Sevoflurane [PS group]. All patients were premedicated using oral midazolam with a maximum dose of 15mg, ondansteron [100 microg/kg] and dexamethasone [0.25-0.5 mg/kg]. In PR Group, anesthesia was induced with propofol 3 mg/kg followed by remifentanil 1 microg/kg; during surgica procedure further injections of remifentanil 0.5 microg/kg were given depending on whether the patient moved or showed signs of awakening in response to skin incision or during the procedure. In PS group; anesthesia was induced with a sleep dose of propofol [3-5 mg/kg] and was continued with 2%-8% sevoflurane and 66% nitrous oxide in oxygen. The minimum sevoflurane concentration used was 2% and was increased up to 8% if the patient moved during skin incision or the procedure. During anesthesia, patients were non-invasively monitored and the times of the start of anesthesia, of the start of the procedure and the time of the end of the procedure and the occurrence of movement during the procedure were noted. During recovery, children were left undisturbed, being called every minute until they first opened their eyes. Anesthetic recovery and distress behavior were assessed using recovery and distress scoring systems. The times at which children first opened their eyes, interacted spontaneously, drank, ate and were ready for discharge from the recovery ward and the hospital were recorded. Incidence of adverse events; hypotension, bradycardia and postoperative nausea and vomiting were monitored throughout the study period. Time till the start of anesthesia was significantly shorter, while time till start of the surgical procedure was non-significantly shorter in PR group compared to that recorded in PS group. Eleven patients; 7 in PS and 4 in PR groups showed minor movement during procedure with a non-significant difference between both groups. All patients were hemodynamically sable throughout the duration of surgery till skin closure and in PACU with a non-significant difference between both groups. Patients included in PR group showed superior emergence off anesttiesia compared to PS group in the form of significantly shorter time to respire spontaneously, to eye opening and to verbalization. Moreover, patients received remifentanil showed significantly shorter time till drinking and eating with significantly shorter PACU and hospital stay in comparison to PS group. Number of patients required rescue analgesia despite increased in both groups, did not show a significant difference. Moreover, mean DS was non-significantly higher in PR group compared to PS group. The incidence of adverse events did not reach the significance level. It can conclude that remifentanil is appropriate for opioid-based anesthesia for children for its provided shorter anesthesia times, hemodynamic stability and rapid recovery characteristics however, attention must be paid for prophylactic antiemesis and proper postoperative analgesia