title: Remifentanil use in pediatric scoliosis surgery-an effective alternative to morphine (a retrospective study).
abstract: OBJECTIVE
  The unique properties of remifentanil make it ideal for pediatric use despite a lack of wide randomized clinical trials and fear of adverse events due to its high potency. We aimed to consolidate preliminary conclusions regarding the efficacy of remifentanil use in pediatric scoliosis surgery.
  
  
  METHODS
  The medical charts of children with idiopathic scoliosis who underwent primary spinal fusion between 1998 and 2007 at a large tertiary university-affiliated hospital were retrospectively reviewed and divided into two groups according to anesthetic regime (remifentanil vs. morphine). Demographic, surgery-related details and immediate postoperative course were recorded and compared.
  
  
  RESULTS
  All 36 remifentanil children were extubated shortly after termination of surgery, compared to 2 of the 84 patients in the morphine group. The remaining patients in the morphine group were extubated hours after surgery [5.4 hours; standard deviation (SD) 1.7 hours]. Six remifentanil children were spared routine intensive care hospitalization (vs. 2 morphine children-significant difference). Shorter surgeries [5.6 hours (SD 1.82 hours) vs. 7.14 hours (SD 2.15 hours); p=0.0004] were logged for the remifentanil group. To achieve controlled hypotension during surgery, vasodilator agents were used in the morphine group only. A comparison of early postoperative major or minor complication rates (including neurological and pulmonary complications) between the two groups yielded no significant differences.
  
  
  CONCLUSIONS
  Remifentanil use can shorten operating time and facilitate earlier spontaneous ventilation and extubation, with less of a need for intensive care hospitalization and no increase in significant complications.
authors.affiliation: Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel. fredricag@asaf.health.gov.il
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Abu-Kishk
authors.forename: Roei
authors.initials: R
authors.lastname: Hod-Feins
authors.forename: Yoram
authors.initials: Y
authors.lastname: Anekstein
authors.forename: Yigal
authors.initials: Y
authors.lastname: Mirovsky
authors.forename: Josi
authors.initials: J
authors.lastname: Barr
authors.forename: Eli
authors.initials: E
authors.lastname: Lahat
authors.forename: Gideon
authors.initials: G
authors.lastname: Eshel
mesh_terms: D002648:Child; D006801:Humans; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D000077208:Remifentanil; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*
chemical_list: D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil