A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia.
BACKGROUND
Fast track anaesthetic protocols for cardiac surgical patients have been developed to facilitate early tracheal extubation. We compared anaesthetics based on either remifentanil or fentanyl for fast track paediatric cardiac anaesthesia.


METHODS
Fifty patients with atrial septal defect or simple ventricular septal defect who were deemed suitable for fast track anaesthetic management were randomly assigned to group R (remifentanil) or group F (fentanyl). After sevoflurane induction, patients received either R infusion or F bolus. Following intubation, isoflurane 0.5 MAC was administered to all patients. Blood pressure (BP) and heart rate (HR) were recorded at baseline and pre- and postinduction, intubation, skin incision and sternotomy. Other parameters measured included time to extubation, reintubation rate and requirements for postoperative analgesia, ondansetron, and nitroprusside in the paediatric intensive care unit.


RESULTS
BP decreased similarly from baseline in both groups. Decreases in HR over time were significantly greater in group R. Haemodynamic response to incision/sternotomy was low and similar in both groups. There were no significant differences in extubation time, reintubation incidence, postoperative narcotic requirements, postoperative hypertension or postoperative nausea/vomiting.


CONCLUSIONS
The remifentanil based anaesthetic was associated with a significantly slower HR than the fentanyl based anaesthetic. The clinical implications of the slower HR during remifentanil anaesthesia could be important and should be investigated.
Friesen
Robert H
RH
Department of Anesthesiology, The Children's Hospital, University of Colorado School of Medicine, 1056 E. 19th Avenue, Denver, CO 80218, USA. friesen.robert@tchden.org
Veit
Andrew S
AS
Archibald
David J
DJ
Campanini
Rafael S
RS
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005283:Fentanyl / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006343:Heart Septal Defects / Q000601:surgery*; D006801:Humans; D010880:Piperidines / Q000627:therapeutic use*; D000077208:Remifentanil; D013997:Time Factors
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl