TOTAL INTRAVENOUS ANESTHESIA WITH PROPOFOL AND REMIFENTANIL IN PEDIATRIC-PATIENTS - A COMPARISON WITH A DESFLURANE-NITROUS OXIDE INHALATIONANESTHESIA

Background: Remifentanil is a new rapid-acting and ultra-short-acting mu-opioid receptor agonist with few reports from use in children. Ther efore, we compared a propofol-remifentanil-anaesthesia (TIVA) with a d esflurane-N2O-anaesthesia (DN) with particular regard to the recovery characteristics in children. Methods: 50 children (4-11 yr) scheduled for ENT surgery were randomly assigned to receive TIVA (n=25) or DN (n =25). After standardised i.v. induction of anaesthesia in both groups with remifentanil, propofol and cisatracurium, TIVA was maintained wit h infusions of propofol and remifentanil. Ventilation was with oxygen in air. DN was maintained with desflurane in 50% N2O. The administrati on of volatile and intravenous anaesthetics was adjusted to maintain a surgical plane of anaesthesia. At the end of surgery all anaesthetics were terminated without tapering and early emergence and recovery wer e assessed. In addition, side effects were noted. Results: Both anaest hesia methods resulted in stable haemodynamics but significantly highe r heart rate with desflurane. Recovery did not differ between the grou ps except for delayed spontaneous respiration after TIVA. Spontaneous ventilation occurred after 11+/-3.7 min versus 7.2+/-2.8 min (mean+/-S D, TIVA versus DN), extubation after 11+/-3.7 min versus 9.4+/-2.9 min , eye opening after 11+/-3.9 min versus 14+/-7.6 min and Aldrete score greater than or equal to 9 after 17+/-6.8 min versus 17+/-7.5 min. Po stoperatively, there was a significant higher incidence of agitation i n the DN-group (80% vs. 44%) but a low incidence (<10%) of nausea and vomiting in both groups. Conclusion: In children, TIVA with remifentan il and propofol is a well-tolerated anaesthesia method, with a lower p eroperative heart rate and less postoperative agitation compared with a desflurane-N2O based anaesthesia.