Comparison of remifentanil versus regional anaesthesia in children anaesthetised with isoflurane/nitrous oxide. International Remifentanil Paediatric Anaesthesia Study group.
We compared the efficacy and safety of a remifentanil (0.25 microg x kg(-1) x min(-1)-based balanced anaesthetic technique with a bupivacaine-based regional anaesthetic technique in an open label, multicentre study in 271 ASA physical status 1 or 2 children aged 1-12 years. Subjects requiring major intra-abdominal, urological or orthopaedic surgery were randomly allocated to receive either intravenous remifentanil (group R; n = 185) or epidural bupivacaine (group B; n = 86) with isoflurane/nitrous oxide for their anaesthesia. The majority of children in both groups (85% in group R, 78% in group B) showed no defined response to skin incision, and although the mean increase in systolic blood pressure (+11 mm Hg) was significantly greater in group R than in group B, this change did not represent a serious haemodynamic disturbance. More children in group R (31%) required interventions to treat hypotension and/or bradycardia than those in group B (12%), but these were easily managed by administration of fluids or anticholinergic drugs. Adverse events, mainly nausea and/or vomiting, occurred in 45% of group R and 42% of group B (NS). The adverse event profile of remifentanil in this study was typical of a potent mu-opioid receptor agonist. Remifentanil was as effective as epidural or caudal block in providing analgesia and suppressing physiological responses to surgical stimuli in children aged between 1 and 12 years undergoing major abdominal, urological, or orthopaedic surgery under isoflurane/nitrous oxide anaesthesia.
Prys-Roberts
C
C
Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Bristol, UK.
Lerman
J
J
Murat
I
I
Taivainen
T
T
Lopez
T
T
Lejus
C
C
Spahr-Schopfer
I
I
Splinter
W
W
Kirkham
A J
AJ
D015360:Analgesia, Epidural; D000701:Analgesics, Opioid; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007530:Isoflurane; D008297:Male; D009609:Nitrous Oxide; D010880:Piperidines; D000077208:Remifentanil
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D010880:Piperidines; D007530:Isoflurane; D009609:Nitrous Oxide; D000077208:Remifentanil; D002045:Bupivacaine