Recovery After Anesthesia for Short Pediatric Oncology Procedures: Propofol and Remifentanil Compared with Propofol, Nitrous Oxide, and Sevoflurane

Abstract

Anesthesia techniques in children undergoing short painful oncology procedures should allow rapid recovery without side effects. We compared the recovery characteristics of two anesthetic techniques: propofol with sevoflurane and nitrous oxide and a total IV technique using propofol and remifentanil. Twenty-one children, undergoing two similar painful procedures within 2 wk were studied in a single-blind manner within patient comparison. The order of the techniques was randomized. Propofol and remifentanil involved bolus doses of both propofol 3-5 mg/kg and remifentanil 1-4 microg/kg. Propofol with sevoflurane and nitrous oxide involved propofol 3-5 mg/kg with 2%-8% sevoflurane and 70% nitrous oxide. The primary outcome variable was the time taken to achieve recovery discharge criteria; other recovery characteristics were also noted. The mean age of the children was 6.5 yr (range, 2.5-9.8 yr). Nineteen had lymphoblastic leukemia and two had lymphoma. All children had intrathecal chemotherapy and one had bone marrow aspiration. Most procedures lasted <4 min. The mean time to achieve recovery discharge criteria was appreciably shorter after propofol and remifentanil than propofol with sevoflurane and nitrous oxide by nearly 19 min (P = 0.001). All other time comparisons had similar trends and statistical differences. Seven parents expressed a preference for the propofol and remifentanil technique compared with one preferring propofol with sevoflurane and nitrous oxide. Children are apneic during the procedure and require respiratory support from an anesthesiologist. Discharge readiness from the recovery ward was achieved on average 19 min earlier after propofol with remifentanil compared with the combination of propofol, sevoflurane and nitrous oxide. Parents more often preferred propofol with remifentanil.

Intravenous remifentanil and propofol for gastroscopy

“…The pharmacodynamic properties of propofol include early return of alertness and decreased postanesthesia nausea and vomiting. Therefore, IV remifentanil combined with propofol seems to be a better anesthetic technique [2].…”

Dexmedetomidine Use during Strabismus Surgery in Agitated Children

“…Candiotti et al [13] reported that less fentanyl was required for sedation with dexmedetomidine (84.8 vs. 144.4 g for the dexmedetomidine and placebo groups, respectively) compared with midazolam (placebo) for all surgical subtypes. Combination of ketamine and dexmedetomidine has several advantages: the decreased dosages of both sedative agents needed for clinical sedation decreased hemodynamic side effects [14] ; intravenous injection enables quicker recovery [15] and causes less air pollution in the operating room than inhaled anesthetics [16] . Mahmoud et al [17] reported that addition of dexmedetomidine decreased the dose of ketamine and thereby its related side effects.…”

Relationship between age and spontaneous ventilation during intravenous anesthesia in children

“…The advantages of propofol and remifentanil, delivered intravenously, over conventional volatile anesthetic agents used in children are quicker recovery (1), reduced nausea and vomiting (2), decreased postoperative delirium (3) and less environmental pollution (4). Organ specific effects, such as reduced airway reactivity, improved postoperative ciliary function (5), maintained cerebral vascular reactivity (6), and preserved middle ear pressure (7) are significant advantages in specific clinical situations.…”