Section Editor: Jerrold Lerman
Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low-dose remifentanil
Article first published online: 4 JUL 2012
© 2012 Blackwell Publishing Ltd
Volume 22, Issue 12, pages 1179–1184, December 2012
How to Cite
Shen, X., Hu, C. and Li, W. (2012), Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low-dose remifentanil. Pediatric Anesthesia, 22: 1179–1184. doi: 10.1111/j.1460-9592.2012.03906.x
- Issue published online: 7 NOV 2012
- Article first published online: 4 JUL 2012
- Accepted 31 May 2012
- respiratory complication;
- volatile anesthetic
Purpose: We aimed to observe the emergence characteristics of children tracheally extubated in deep anesthesia with sevoflurane or sevoflurane in combination with low-dose remifentanil.
Methods: We randomly allocated 50 pediatric patients undergoing elective electronic cochlear implantation to groups either receiving sevoflurane (Group S, n = 25), or sevoflurane plus low-dose remifentanil (Group SR, n = 25), during extubation from anesthesia. In Group S, subjects were tracheally extubated while breathing 1.3 times the minimal effective concentration of sevoflurane. In Group SR, subjects were tracheally extubated while breathing 1.0 times the minimal effective concentration of sevoflurane with 0.02–0.05 μg·kg−1 per min remifentanil. Recovery characteristics and airway complications were noted.
Results: There was no significant difference in age, weight, sex, and duration of anesthesia. The average remifentanil rate was 0.036 μg·kg−1 per min, and compared with Group S, patients in Group SR had a lower respiratory rate (17.3 vs 20.2 per minute, P < 0.05) and a higher ETCO2 (52.3 vs 49.4 mmHg, P < 0.05). Oral airway usage was also less frequent in Group SR (44% vs 16%, P < 0.01). Additionally, the time from extubation to spontaneous eye opening was shorter in Group SR (10.9 min vs 19.6 min, P < 0.01). Finally, six patients in Group S and five patients in Group SR had a pediatric anesthesia emergence delirium score >10.
Conclusions: Low-dose remifentanil in combination with sevoflurane provided rapid recovery and was safe for deep tracheal extubation in deep anesthesia in pediatric patients.