Experience with remifentanil-sevoflurane balanced anesthesia for abdominal surgery in neonates and children less than 2 years.
BACKGROUND
Few data report remifentanil use in the neonatal population. We described here our experience with remifentanil-sevoflurane balanced anesthesia in neonates and children less than 2 years who underwent general anesthesia for abdominal surgery.


METHODS
We retrospectively studied the pattern of remifentanil infusion associated with sevoflurane inhalation in preterm neonates (PTN; n = 18) (born before 37 weeks of gestation and <45 weeks of postmenstrual age), full-term neonates (FTN; n = 21) (born after 37 weeks of gestation and less than 29 days old) and older children up to 2 years (CUT; n = 24). We recorded heart rate (HR), mean arterial pressure (MAP), mean remifentanil dose and sevoflurane concentration before incision and at 5, 10, 20, 30, 45, 60, 90, and 105 min after incision.


RESULTS
We observed that remifentanil doses used during surgery were lower in PTN than in both FTN and CUT and lower in FTN than in CUT. This was because of a progressive decrease in remifentanil dose during anesthesia in PTN and FTN. Conversely, remifentanil doses increased in CUT during anesthesia. Sevoflurane concentrations were higher in CUT group than in PTN and FTN groups. MAP and HR did not vary in the three groups during anesthesia.


CONCLUSIONS
Remifentanil-sevoflurane anesthesia can be used for general anesthesia in neonates. We observed that anesthetists used lower doses of remifantanil and lower concentrations of sevoflurane in neonates compared with the older children.
Michel
Fabrice
F
Département d'Anesthésie et de Réanimation, Centre Hospitalo-Universitaire Nord, Marseille, France. fabrice.michel@ap-hm.fr
Lando
Annie
A
Aubry
Christine
C
Arnaud
Sophie
S
Merrot
Thierry
T
Martin
Claude
C
D000005:Abdomen / Q000601:surgery; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000378:metabolism; D000704:Analysis of Variance; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000378:metabolism; D010880:Piperidines / Q000008:administration & dosage / Q000378:metabolism; D000077208:Remifentanil; D012189:Retrospective Studies; D000077149:Sevoflurane; D013997:Time Factors
D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil