Remifentanil versus fentanyl for esophagogastroduodenoscopy in children.
OBJECTIVE
We compared sedation by propofol combined with either fentanyl or remifentanil in pediatric outpatients undergoing diagnostic esophagogastroduodenoscopy.


METHODS
Forty-two children scheduled for esophagogastroduodenoscopy in our institution were randomly assigned to receive 2 mg/kg propofol plus either 1 μg/kg bolus of fentanyl (group F; n = 20) or 0.5 μg/kg bolus of remifentanil (group R; n = 22). Cardiorespiratory parameters, sedation level, adverse effects related to the drugs and/or to the procedure, ease of performance for the endoscopist, and time to awakening were analyzed.


RESULTS
There were no clinically significant changes in hemodynamics. Apnea periods >20 seconds and decreases in SaO2 <90% occurred more frequently in group R (31.8% vs 0%, P < 0.01, and 27.3% vs 5.0%, P > 0.05, respectively). Children in group R had significantly shorter average time to awakening: 9.5 ± 5.6 vs 16.5 ± 10.5 minutes (P = 0.01), and received a significantly lower total dose of propofol (P = 0.034). Adverse effects within the first 24 hours postprocedure occurred less frequently in group R (P = 0.03).


CONCLUSIONS
Remifentanil in combination with propofol provides good analgesic and sedative effects, which were shorter lasting compared with fentanyl-based sedation, and caused fewer delayed adverse effects. The use of remifentanil was associated with respiratory depression, emphasizing the need for experienced anesthesiologists.
Hirsh
Irina
I
Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel. hi767682@yahoo.com
Lerner
Aaron
A
Shnaider
Ilia
I
Reuveni
Amit
A
Pacht
Avi
A
Segol
Ori
O
Pizov
Reuven
R
D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001049:Apnea / Q000209:etiology / Q000517:prevention & control; D002648:Child; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D015742:Propofol / Q000009:adverse effects; D000077208:Remifentanil; D014851:Wakefulness / Q000187:drug effects
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol