Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants.
BACKGROUND
Propofol-remifentanil anesthesia is widely used in adults but few studies are available in infants. We aimed at comparing the hemodynamic effects of propofol-remifentanil vs sevoflurane-fentanyl anesthesia. In addition, we sought to investigate recovery and whether remifentanil induced acute opioid tolerance.


METHODS
In total, 39 infants 4-6 months old were prospectively enrolled and randomized to receive either a combination of remifentanil and propofol (n = 17) or a sevoflurane-fentanyl anesthesia (n = 22) for surgical repair of cleft lip and palate. In both groups, sevoflurane was used for induction of anesthesia and fentanyl was administered before tracheal extubation. Mean arterial blood pressure and heart rate were recorded every 5 min after induction. We also recorded time from termination of surgery to tracheal extubation, postoperative behavior and the need for analgesia for the first 24 h after surgery. Postoperative observations were blinded.


RESULTS
In the remifentanil-propofol group, the mean arterial blood pressure was higher [58 (51-65) vs 51 (45-55), P = 0.02] and the mean heart rate was lower [111 (108-113) vs 128 (122-143), P < 0.0001]. There were no differences in recovery time or behavior after surgery. In the remifentanil group, a median fentanyl dose of 4 microg x kg(-1) was required to insure a smooth recovery, but there was no difference in morphine consumption during the first 24 h after surgery.


CONCLUSIONS
A high-dose remifentanil-propofol infusion was associated with a higher blood pressure and lower heart rate than sevoflurane-fentanyl anesthesia in infants. Postoperative morphine consumption, recovery time and quality were similar.
Steinmetz
Jacob
J
Department of Anesthesia, Centre of Head and Orthopedics, Copenhagen University Hospital, Copenhagen, Denmark. jacobsteinmetz@dadlnet.dk
Holm-Knudsen
Rolf
R
Sørensen
Martin Kryspin
MK
Eriksen
Kirsten
K
Rasmussen
Lars S
LS
D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects*; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects / Q000494:pharmacology*; D009056:Mouth Abnormalities / Q000601:surgery*; D010880:Piperidines / Q000009:adverse effects / Q000494:pharmacology*; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology*; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D013997:Time Factors
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol