[Sedation with remifentanil for tracheostomy in a pediatric patient].
Remifentanil is an ultra-short-acting opioid that is frequently used in adults for surgical anesthesia or conscious sedation, but its use in children is much less common. We report the case of a 7-year-old boy with lateral cervical tumors displacing all cervical and facial structures. An emergency tracheostomy was performed when he developed respiratory difficulty due to partial airway obstruction. Because of the size and location of the intraoral tumors and a history of bleeding, orotracheal intubation and other airway management techniques were ruled out. The tracheostomy was performed under local anesthesia and sedation with a perfusion of 0.05 x microgKg(-1) x min(-1) provided the necessary relaxation and immobility for surgery. Sedation under observation with monitoring is among the indications of remifentanil. Spontaneous breathing is maintained with infusions less than 0.05 to 0.1 microg x Kg(-1) x min(-1). In the case we report, the patient's risk of complete airway obstruction due to bleeding upon manipulation had to be assessed and compared with the respiratory depression that might possibly have been caused by remifentanil perfusion. We judged that the option of sedation would cause less morbidity and offered greater safety for the patient. The outcome of this case is consistent with reports that remifentanil is a good option for adequately sedating children who are breathing spontaneously.
Vidal
M A
MA
Departamento de Anestesia, Reanimación y Unidad del Dolor. Hospital Universitario. Puerta del Mar. Cádiz.
Velázquez
A
A
Morgado
I
I
Pérez Bustamante
F
F
Torres
L M
LM
D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D002648:Child; D016292:Procedural Sedation; D006258:Head and Neck Neoplasms / Q000150:complications; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D012307:Risk Factors; D014139:Tracheostomy
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil