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PEDIATRIC ANESTHESIA

A Randomized Multicenter Study of Remifentanil Compared with Halothane in Neonates and Infants Undergoing Pyloromyotomy. I. Emergence and Recovery Profiles

Peter J. Davis, MD^*, Jeffrey Galinkin, MD, Francis X. McGowan, MD, Anne M. Lynn, MD, Myron Yaster, MD^||||, Mary F. Rabb, MD^¶, Elliot J. Krane, MD^#, C. Dean Kurth, MD^**, Richard H. Blum, MD, Lynne Maxwell, MD, Rosemary Orr, MD, Peter Szmuk, MD^¶, Daniel Hechtman, MD^||||||||, Suzanne Edwards, DrPH^¶¶, and Lynn Graham Henson, PharmD^##

*Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, and Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Anesthesiology, Children’s Hospital of Philadelphia, and Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiac Anesthesia, Children’s Hospital, and Department of Anesthesia, Harvard Medical School, Boston, Massachusetts; Children’s Hospital and Regional Medical Center, Departments of Anesthesiology and Pediatrics, University of Washington, School of Medicine, Seattle, Washington; ||||Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins University, Baltimore, Maryland; ¶Department of Anesthesiology, University of Texas-Houston Medical School, Houston, Texas; #Department of Anesthesiology, Lucile S. Packard Children’s Hospital at Stanford, and Departments of Anesthesiology and Pediatrics, Stanford University, Stanford, California; **Departments of Anesthesiology and Pediatrics, University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Anaesthesia, Harvard Medical School, and Department of Anesthesia, Children’s Hospital, Boston, Massachusetts; Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins University, Baltimore, Maryland; Children’s Hospital and Regional Medical Center, and Department of Anesthesiology, University of Washington, School of Medicine, Seattle, Washington; ||||||||Children’s Hospital of Pittsburgh, and Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and ¶¶Clinical Statistics Department and ##Anesthesia Clinical Development, Glaxo Wellcome, Inc., Research Triangle Park, North Carolina

Address correspondence and reprint requests to Peter J. Davis, MD, Department of Anesthesiology, Children’s Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA 15213-2583. Address e-mail to davispj{at}anes.upmc.edu

Pyloric stenosis is sometimes associated with hemodynamic instability and postoperative apnea. In this multicenter study we examined the hemodynamic response and recovery profile of remifentanil and compared it with that of halothane in infants undergoing pyloromyotomy. After atropine, propofol, and succinylcholine administration and tracheal intubation, patients were randomized (2:1 ratio) to receive either remifentanil with nitrous oxide and oxygen or halothane with nitrous oxide and oxygen as the maintenance anesthetic. Pre- and postoperative pneumograms were done and evaluated by an observer blinded to the study. Intraoperative hemodynamic data and postanesthesia care unit (PACU) discharge times, PACU recovery scores, pain medications, and adverse events (vomiting, bradycardia, dysrhythmia, and hypoxemia) were recorded by the study’s research nurse. There were no significant differences in patient age or weight between the two groups. There were no significant differences in hemodynamic values between the two groups at the various intraoperative stress points. The extubation times, PACU discharge times, pain medications, and adverse events were similar for both groups. No patient anesthetized with remifentanil who had a normal preoperative pneumogram had an abnormal postoperative pneumogram, whereas three patients with a normal preoperative pneumogram who were anesthetized with halothane had abnormal pneumograms after.

IMPLICATIONS: The use of ultra-short-acting opioids may be an appropriate technique for infants less than 2 mo old when tracheal extubation after surgery is anticipated.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999