title: A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing pyloromyotomy. I. Emergence and recovery profiles.
abstract: Pyloric stenosis is sometimes associated with hemodynamic instability and postoperative apnea. In this multicenter study we examined the hemodynamic response and recovery profile of remifentanil and compared it with that of halothane in infants undergoing pyloromyotomy. After atropine, propofol, and succinylcholine administration and tracheal intubation, patients were randomized (2:1 ratio) to receive either remifentanil with nitrous oxide and oxygen or halothane with nitrous oxide and oxygen as the maintenance anesthetic. Pre- and postoperative pneumograms were done and evaluated by an observer blinded to the study. Intraoperative hemodynamic data and postanesthesia care unit (PACU) discharge times, PACU recovery scores, pain medications, and adverse events (vomiting, bradycardia, dysrhythmia, and hypoxemia) were recorded by the study's research nurse. There were no significant differences in patient age or weight between the two groups. There were no significant differences in hemodynamic values between the two groups at the various intraoperative stress points. The extubation times, PACU discharge times, pain medications, and adverse events were similar for both groups. No patient anesthetized with remifentanil who had a normal preoperative pneumogram had an abnormal postoperative pneumogram, whereas three patients with a normal preoperative pneumogram who were anesthetized with halothane had abnormal pneumograms after.
  
  
  CONCLUSIONS
  The use of ultra-short-acting opioids may be an appropriate technique for infants less than 2 mo old when tracheal extubation after surgery is anticipated.
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-2583, USA. davispj@anes.upmc.edu
authors.forename: P J
authors.initials: PJ
authors.lastname: Davis
authors.forename: J
authors.initials: J
authors.lastname: Galinkin
authors.forename: F X
authors.initials: FX
authors.lastname: McGowan
authors.forename: A M
authors.initials: AM
authors.lastname: Lynn
authors.forename: M
authors.initials: M
authors.lastname: Yaster
authors.forename: M F
authors.initials: MF
authors.lastname: Rabb
authors.forename: E J
authors.initials: EJ
authors.lastname: Krane
authors.forename: C D
authors.initials: CD
authors.lastname: Kurth
authors.forename: R H
authors.initials: RH
authors.lastname: Blum
authors.forename: L
authors.initials: L
authors.lastname: Maxwell
authors.forename: R
authors.initials: R
authors.lastname: Orr
authors.forename: P
authors.initials: P
authors.lastname: Szmuk
authors.forename: D
authors.initials: D
authors.lastname: Hechtman
authors.forename: S
authors.initials: S
authors.lastname: Edwards
authors.forename: L G
authors.initials: LG
authors.lastname: Henson
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D006221:Halothane / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009609:Nitrous Oxide; D010149:Postoperative Pain / Q000628:therapy; D010880:Piperidines / Q000009:adverse effects; D011183:Postoperative Complications; D011707:Pyloric Stenosis / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D010880:Piperidines; D009609:Nitrous Oxide; D000077208:Remifentanil; D006221:Halothane