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PEDIATRIC ANESTHESIA

Quality Differences in Postoperative Sleep Between Propofol-Remifentanil and Sevoflurane Anesthesia in Infants

Jacob Steinmetz, MD^*, Rolf Holm-Knudsen, MD^*, Kirsten Eriksen, MD^*, Dorte Marxen, RN, and Lars S. Rasmussen, MD, PhD^*

From the *Department of Anesthesia, Centre of Head and Orthopedics 4231, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and Centre of Cleft Lip-Palate, Rygaards Allé 45, Denmark.

Address correspondence and reprint requests to Jacob Steinmetz, MD, Department of Anesthesia, Centre of Head and Orthopedics 4231, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Address e-mail to jacobsteinmetz{at}dadlnet.dk.

BACKGROUND: Postoperative behavioral disorders are common in children, but the occurrence in infants is not yet clear. In the present study we focus on postoperative sleep disturbances, which we hypothesized would be more common after sevoflurane anesthesia than propofol-remifentanil anesthesia.

METHODS: In total, 39 infants 4–6-mo-old were prospectively enrolled and randomized to receive either a combination of propofol and remifentanil (n = 17) or sevoflurane and fentanyl anesthesia (n = 22) for surgical repair of cleft lip-gum-palate. Postoperative observations were blinded. The parents kept a sleep diary for 2 wk before admission and 2 wk after returning home. The diary included information about how many times the infant awoke during the night and was difficult to comfort and the longest duration of continuous sleep during the night.

RESULTS: Longest continuous sleep was significantly longer in the sevoflurane group (median 7.2 h) compared with the propofol-remifentanil group (median 5.1 h, P < 0.05). No other significant difference was found between groups. Sleep pattern was impaired after surgery in both groups compared with that before surgery (P < 0.01), but it was considered by the parents to be back to normal after a median of 10 days, with no significant difference between groups.

CONCLUSION: Postoperative sleep disturbances occur in infants after both propofol-remifentanil and sevoflurane anesthesia. Sevoflurane seems to be associated with less impairment of postoperative sleep than propofol-remifentanil in the first weeks after repair of cleft lip and palate in infants.