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Remifentanil Infusion for Cleft Palate Surgery in Young Infants

Review: The goal of the study was to compare a remifentanil-based anesthesia technique with a sufentanil-based anesthesia technique in infants undergoing primary cleft palate repair. This prospective study consisted of 40 patients, aged 2-12 months (24 males and 16 females). American Society of Anesthesiologists physical status I or II; born at full term, and scheduled for cleft palate repair. Exclusion criteria for this study were patients with a history of apnea and conditions such as Pierre-Robin syndrome. Patients were randomized to receive either remifentanil or sufentanil during the procedure.

Premedication with rectal midazolam 0.3 mg/kg was administered to all of the infants in the study. An inhalation induction consisting of sevoflurane in oxygen and nitrous oxide was the technique of choice. After induction an intravenous catheter was inserted, and then followed by endotracheal intubation. No neuromuscular blocking agents were administered. Anesthesia maintenance consisted of either remifentanil or sufentanil with isoflurane at an end-tidal concentration of 1.2% in nitrous oxide and oxygen (50%:50%) to which patients were randomized. During the surgery, end-tidal carbon dioxide was maintained at 32 - 35 mm Hg. Those patients randomized to receive remifentanil were given a continuous infusion that was started at 0.25 mcg/kg/min. The other patients randomized to receive sufentanil were administered an initial bolus of 0.3 mcg/kg. The need to increase the maintenance anesthetics in response to hypertension and tachycardia was similar in both groups. On the contrary, one infant developed sustained bradycardia and hypotension in the remifentanil group.

Approximately 30 minutes before the end of surgery, the infants of both groups received an injection of propacetamol IV (30 mg/kg). The patients in the remifentanil group also received a bolus of morphine 0.1 mg/kg. In the sufentanil group, additional sufentanil was not administered during the last 30 mins of surgery. In both groups, the maintenance isoflurane concentration had been tapered. At the completion of surgery, nitrous oxide and remifentanil were discontinued. Following extubation, patients were transferred to the PACU and monitored there until the next morning. The investigators examined pain score, respiratiory rate, level of sedation, breathing pattern and pulse oximetry.

Following final analysis of the data, this study showed similar hemodynamic stability and anesthetic recovery variables with remifentanil compared to sufentanil.

Comments: This study is the first to look at the hemodynamic response and recovery profile of remifentanil compared with sufentanil in infants undergoing primary cleft palate repair. The results of this study are worth consideration, and you may want to incorporate the information into your own practice. Over the course of the past year, I have reviewed several studies incorporating remifentanil into the anesthesia technique. The use of remifentanil in pediatric anesthesia appears to be ever expanding. There are issues that the reader of this study should keep in mind. In this study, remifentanil was used at a high infusion rate (greater than 0.30 mcg/kg/min). Additionally, the use of remifentanil failed to demonstrate any significant advantage over sufentanil in the conditions of this study.

Table of Contents

• President's Message
• Editor's Corner
• Joint Meeting of SPA and JSPA
• Out and About the ASA
  • Pediatric Clinical Forum at ASA
  • Pediatric Panel: Pediatric Pain Management
  • Controversies in Malignant Hyperthermia, Cases from the MH Hotline
  • American Academy of Pediatrics Secion on Anesthesiology Breakfast Panel
  • Tuesday Morning general Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia
• American Academy of Pediatrics Section on Anesthesia and Pain Medicine Update
• Fellows Corner
  • Non-ACGME Approved Fellowship Training Programs for Pediatric Anesthesia
• WEB ONLY
  • SPA Governmental Affairs Committee Report
  • Literature Review: Hyperkalemia and Pyloric Stenosis
  • Literature Review: Early Exposure to Common Anesthetic Agents Causes Widespread Neurodegeneration in the Developing Rat Brain and Persistent Learning Deficits
  • Laryngeal mask insertion in children: a rational approach
  • Remifentanil Infusion for Cleft Palate Surgery in Young Infants
  • Tuesday Morning General Pediatric Anesthesia Poster Discussions and Poster Sessions of General Pediatric and Pediatric Cardiac Anesthesia

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