A randomized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients

We compared, in a double-blinded manner, the anesthetic maintenance and rec overy properties of remifentanil with a clinically comparable fentanyl-base d anesthetic technique in pediatric ambulatory surgical patients. Anesthesi a was induced with either halothane or sevoflurane and nitrous oxide and ox ygen. Patients were randomized (computer generated) to receive either remif entanil or fentanyl in a blinded syringe with nitrous oxide and oxygen in o ne of four possibilities: halothane/remifentanil, halothane/ fentanyl, sevo flurane/remifentanil or sevoflurane/ fentanyl. In patients receiving remife ntanil, a placebo bolus was administered, and a continuous infusion (0.25 m u g . kg(-1) . min(-1)) was begun. In patients receiving fentanyl, a bolus (2 mu g/kg) was administered followed by a placebo continuous infusion. The time from discontinuation of the anesthetic to extubation, discharge from the postanesthesia care unit (PACU), and discharge to home, as well as pain scores, were assessed by a blinded nurse observer. Systolic blood pressure and heart rate were noted at selected times, and adverse events were recor ded. Remifentanil provided faster extubation times and higher pain-discomfo rt scores. PACU and hospital discharge times were similar. There were no st atistical differences among the groups for adverse events. There were stati stically, but not clinically significant differences in hemodynamic variabl es. We noted that continuous infusions of remifentanil were intraoperativel y as effective as bolus fentanyl. Although patients could be tracheally ext ubated earlier with remifentanil, this did not translate to earlier PACU or hospital discharge times. In addition, remifentanil was associated with hi gher postoperative pain scores. The frequent incidence of postoperative pai n observed in the postoperative recovery room suggests that better intraope rative prophylactic analgesic regimens for postoperative pain control are n ecessary to optimize remifentanil's use as an anesthetic for children. Impl ications: This is a study designed to examine the efficacy and safety of a short-acting opioid, remifentanil, when used in pediatric patients. The fre quent incidence of postoperative pain observed in the postoperative recover y room suggests that better intraoperative prophylactic analgesic regimens for postoperative pain control are necessary to optimize remifentanil's use as an anesthetic for children.