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PEDIATRIC ANESTHESIOLOGY

Intraoperative Low-Dose Ketamine Does Not Prevent a Remifentanil-Induced Increase in Morphine Requirement After Pediatric Scoliosis Surgery

From the *Department of Anesthesia, and the Division of Orthopedic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Dr. Crawford, Department of Anesthesia, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8. Address e-mail to mark.crawford{at}sickkids.ca.

Abstract

BACKGROUND: Remifentanil-based anesthesia is commonly used to facilitate neurophysiologic monitoring during pediatric scoliosis surgery. Acute opioid tolerance and/or hyperalgesia resulting from remifentanil-based anesthesia may involve activation of N-methyl-d-aspartate systems. We hypothesized that low-dose intraoperative infusion of the N-methyl-d-aspartate antagonist ketamine would suppress the development of tolerance and thereby decrease postoperative morphine consumption in children receiving remifentanil-based anesthesia for scoliosis surgery.

METHODS: Thirty-four adolescents aged 12–18 yr scheduled for scoliosis surgery were randomly assigned to receive intraoperative low-dose ketamine (bolus dose of 0.5 mg/kg followed by continuous infusion of 4 µg · kg^–1 · min^–1) or an equal volume of saline during propofol/remifentanil anesthesia. Cumulative morphine consumption was assessed using a patient-controlled analgesia device for 72 h after surgery. Postoperative morphine consumption, pain scores at rest and during cough, and sedation scores were recorded by a blinded investigator every hour for the first 4 h, every 4 hours for 20 h, and then every 12 hours for 72 h.

RESULTS: Cumulative morphine consumption at 24, 48, and 72 h after surgery did not differ significantly between groups (ketamine group: 1.57 ± 0.56, 3.05 ± 1.14, and 4.46 ± 1.53 mg/kg; saline group: 1.60 ± 0.53, 2.87 ± 1.05, and 4.11 ± 1.71 mg/kg, respectively). No differences in pain or sedation scores were found. The duration of anesthesia was similar in the two groups.

CONCLUSIONS: These data do not support the use of intraoperative low-dose ketamine to prevent the development of remifentanil-induced acute opioid tolerance and/or hyperalgesia during pediatric scoliosis surgery.

This article has been cited by other articles:

				B. Ben-David and J. E. Chelly Propofol Alters Ketamine Effect on Opiate-Induced Hyperalgesia Anesth. Analg., April 1, 2009; 108(4): 1353 - 1353. [Full Text] [PDF]

				T. Engelhardt and M. W. Crawford Propofol Alters Ketamine Effect on Opiate-Induced Hyperalgesia Anesth. Analg., April 1, 2009; 108(4): 1353 - 1354. [Full Text] [PDF]