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PEDIATRIC ANESTHESIA

A Randomized Multicenter Study of Remifentanil Compared with Halothane in Neonates and Infants Undergoing Pyloromyotomy. II. Perioperative Breathing Patterns in Neonates and Infants with Pyloric Stenosis

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

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

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

Although former preterm birth infants are at risk for postoperative apnea after surgery, it is unclear whether the same is true of full-term birth infants. We evaluated the incidence of apnea in 60 full-term neonates and infants undergoing pyloromyotomy both before and after anesthesia. All subjects were randomized to a remifentanil- or halothane-based anesthetic. Apnea was defined by the presence of prolonged apnea (>15 s) or frequent brief apnea, as observed on the pneumocardiogram. Apnea occurred before surgery in 27% of subjects and after surgery in 16% of subjects, with no significant difference between subjects randomized to remifentanil or halothane anesthesia. This apnea was primarily central in origin, occurred throughout the recording epochs, and was associated with severe desaturation in some instances. Of the subjects with normal preoperative pneumocardiograms, new onset postoperative apnea occurred in 3 (23%) of 13 subjects who received halothane-based anesthetics versus 0 (0%) of 22 subjects who received remifentanil-based anesthetics (P = 0.04). Thus, postoperative apnea can follow anesthesia in otherwise healthy full-term infants after pyloromyotomy and is occasionally severe with desaturation. New-onset postoperative apnea was not seen with a remifentanil-based anesthetic.

IMPLICATIONS: Abnormal breathing patterns can follow anesthesia in infants after surgical repair of pyloric stenosis. Occasionally, these patterns can be associated with desaturation. New-onset postoperative apnea was not seen with a remifentanil-based anesthetic.

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