Document Detail


Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants.
MedLine Citation:
PMID:  17184429     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance. METHODS: In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded. RESULTS: In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery. CONCLUSIONS: A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.
Authors:
Jacob Steinmetz; Rolf Holm-Knudsen; Martin Kryspin Sørensen; Kirsten Eriksen; Lars S Rasmussen
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  17     ISSN:  1155-5645     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-22     Completed Date:  2007-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  32-7     Citation Subset:  IM    
Affiliation:
Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Copenhagen, Denmark. jacobsteinmetz@dadlnet.dk
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MeSH Terms
Descriptor/Qualifier:
Anesthesia Recovery Period
Anesthetics, Combined / adverse effects,  pharmacology
Anesthetics, Inhalation / adverse effects,  pharmacology
Anesthetics, Intravenous / adverse effects,  pharmacology
Blood Pressure / drug effects*
Cleft Lip / surgery
Cleft Palate / surgery
Dose-Response Relationship, Drug
Female
Heart Rate / drug effects*
Humans
Infant
Intubation, Intratracheal / methods
Male
Methyl Ethers / adverse effects,  pharmacology*
Mouth Abnormalities / surgery*
Piperidines / adverse effects,  pharmacology*
Propofol / adverse effects,  pharmacology*
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Anesthetics, Combined; 0/Anesthetics, Inhalation; 0/Anesthetics, Intravenous; 0/Methyl Ethers; 0/Piperidines; 132875-61-7/remifentanil; 2078-54-8/Propofol; 28523-86-6/sevoflurane

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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