A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing pyloromyotomy. II. Perioperative breathing patterns in neonates and infants with pyloric stenosis.
Although former preterm birth infants are at risk for postoperative apnea after surgery, it is unclear whether the same is true of full-term birth infants. We evaluated the incidence of apnea in 60 full-term neonates and infants undergoing pyloromyotomy both before and after anesthesia. All subjects were randomized to a remifentanil- or halothane-based anesthetic. Apnea was defined by the presence of prolonged apnea (>15 s) or frequent brief apnea, as observed on the pneumocardiogram. Apnea occurred before surgery in 27% of subjects and after surgery in 16% of subjects, with no significant difference between subjects randomized to remifentanil or halothane anesthesia. This apnea was primarily central in origin, occurred throughout the recording epochs, and was associated with severe desaturation in some instances. Of the subjects with normal preoperative pneumocardiograms, new onset postoperative apnea occurred in 3 (23%) of 13 subjects who received halothane-based anesthetics versus 0 (0%) of 22 subjects who received remifentanil-based anesthetics (P = 0.04). Thus, postoperative apnea can follow anesthesia in otherwise healthy full-term infants after pyloromyotomy and is occasionally severe with desaturation. New-onset postoperative apnea was not seen with a remifentanil-based anesthetic.


CONCLUSIONS
Abnormal breathing patterns can follow anesthesia in infants after surgical repair of pyloric stenosis. Occasionally, these patterns can be associated with desaturation. New-onset postoperative apnea was not seen with a remifentanil-based anesthetic.
Galinkin
J L
JL
Department of Anesthesiology, Children's Hospital of Philadelphia, Pennsylvania, USA.
Davis
P J
PJ
McGowan
F X
FX
Lynn
A M
AM
Rabb
M F
MF
Yaster
M
M
Henson
L G
LG
Blum
R
R
Hechtman
D
D
Maxwell
L
L
Szmuk
P
P
Orr
R
R
Krane
E J
EJ
Edwards
S
S
Kurth
C D
CD
D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001049:Apnea / Q000139:chemically induced; D006221:Halothane / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010880:Piperidines / Q000009:adverse effects*; D011183:Postoperative Complications; D011707:Pyloric Stenosis / Q000601:surgery*; D011708:Pylorus / Q000601:surgery; D000077208:Remifentanil; D012119:Respiration / Q000187:drug effects*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D006221:Halothane