REMIFENTANIL AS A MODALITY OF OPIOID BASED ANESTHESIA IN PEDIATRICS

Purpose: This study was designed to compare the analgesic requirements intra-operatively and postoperatively and side effects of using fentanyl infusion versus remifentanil infusion in conjunction with a volatile anesthetic during short-duration surgical procedures in children. Patients Methods: The study comprised 40 children, 24 males and 16 females with mean age of 5.4±1.4 years, randomly allocated into 2 equal groups: fentanyl (F-group) or remifentanil (R-group). Fentanyl was administered as a continuous IV infusion initiallyat 5 ^g/kg/min, after endotracheal intubation, infusion rate was reduced to 2.5 ^g/kg/min and then, was adjusted to treat light anesthesia responses, while remifentanil was given as a continuous IV infusion initially at 0.5 ^g/kg/min, after endotracheal intubation, infusion rate was reduced to 0.25 ^g/kg/min and then, was adjusted to treat light anesthesia responses that were recorded at time of induction, one and 5 min after intubation, at time of skin incision and closure, and 5-min after transfer to recovery room (RR). Ten minutes before end of surgery, the infusion rate was decreased to 0.5 ^g/kg/min in the (F) group and was decreased to 0.05 ^g/kg/min in the (R) group and stopped at end of surgery. Anestheticrecovery was assessed using the Brussels sedation scale every 5 min since entry till discharge from RR and the RR-discharge time was defined as the time elapsed from cessation of the anesthetic till reaching level 4 on Brussels sedation scale. Postoperative (PO) analgesia was assessed throughout the 1st 3 PO hours using observational pain-discomfort scale (OPS) and adverse events were recorded. Results: Hemodynamic variables showed a non-significant difference between both groups. Patients received remifentanil showed significantly (p 0.05) shorter time to respire spontaneously, to eye opening, to extubation and to verbalizationcompared to those received fentanyl. Time to qualify for RR discharge was significantly shorter (p=0.036) in R-group (20.5±5 min) compared to F-group (24.9±5.5 min) and 18 patients (90%) fulfilled criteria for recovery room discharge at 25 min in R-group, with a significant difference (p=0.01) in favor of remifentanil. Fentanyl provided significantly better PO analgesia than remifentanil, children in F-group showed a significantly (p=0.028) lower mean cumulative OPS record than those in R-group, but number of patients required rescue analgesia did not show a significant difference between both groups. Two cases in F-group and one in R-group had bradycardia, one case in R-group had mild hypotension and PO vomiting had occurred in 3 patients F-group and 2 patients in R-group. Conclusion: Out of the obtained results, we can conclude that remifentanil is appropriate for opioid-based anesthesia for pediatric patients for its provided hemodynamic stability, rapid recovery characteristics with minimal postoperative side effects; however, attention must be paid for prophylactic antiemesis and proper postoperative analgesia.