Remifentanil infusion for cleft palate surgery in young infants.
BACKGROUND
The residual depressant effect of opioid is a major concern in infants scheduled for cleft palate repair. Remifentanil is associated with a fast and predictable recovery, independent of age.


METHODS
About 40 infants in the 2-12 month age range were prospectively enrolled in this open study, to receive either remifentanil (infusion starting at 0.25 microg x kg(-1) x min(-1)) or sufentanil as part of a balanced anaesthesia regimen. Isoflurane was maintained at an endtidal concentration of 1.2% in oxygen and nitrous oxide and the opioid dosing was titrated to autonomic responses. Postoperative pain relief was provided by morphine infusion. Morphine administration started intraoperatively in the remifentanil group.


RESULTS
Consistent haemodynamic stability was achieved throughout surgery in both groups. Infants of the remifentanil group required, on average, lower concentrations of isoflurane than children of the sufentanil group (1.2 +/- 0.2% vs 1.7 +/- 0.3%, P < 0.001). The median time from last suture to tracheal extubation was 12.5 min (5-25 min) in the remifentanil group and 15.0 min (10-30 min) in the sufentanil group. There was no evidence of hyperalgesia or enhanced morphine consumption in the remifentanil group compared with the sufentanil group. Postoperative pain scores were even lower in the remifentanil group, compared with the sufentanil group, soon after arrival in the postanaesthesia care unit.


CONCLUSIONS
Remifentanil-based anaesthesia appeared well suited for primary cleft palate repair in young infants.
Roulleau
P
P
Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Armand Trousseau, Asssistance Publique des Hôpitaux de Paris, Paris, France.
Gall
O
O
Desjeux
L
L
Dagher
C
C
Murat
I
I
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D018685:Anesthetics, Inhalation / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007530:Isoflurane / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D017409:Sufentanil / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D010880:Piperidines; D009020:Morphine; D017409:Sufentanil; D007530:Isoflurane; D000077208:Remifentanil