Korean J Anesthesiol.  2011 Aug;61(2):148-153. 10.4097/kjae.2011.61.2.148.

The effect of remifentanil versus N2O on postoperative pain and emergence agitation after pediatric tonsillectomy/adenoidectomy

• Choi HR
• Cho JK
• Lee S
• Yoo BH
• Yon JH
• Kim KM

• KMID: 1766710
• DOI: http://doi.org/10.4097/kjae.2011.61.2.148

Abstract

BACKGROUND
Remifentanil can be an alternative to N2O in general anesthesia. Intraoperative remifentanil may lead to acute opioid tolerance. This study aims to assess the effect of remifentanil substituted for 70% N2O on postoperative pain in children undergoing tonsillectomy/adenoidectomy. In addition, we evaluated the effect of remifentanil infusion on incidence of emergence agitation in these patients.
METHODS
Eighty children, aged 2-12 years, undergoing tonsillectomy/adenoidectomy were randomly allocated to the N2O group (Group N; n = 40, sevoflurane and 70% N2O) or remifentanil group (Group R; n = 40, sevoflurane with remifentanil infusion at the rate of 0.17 microg/kg/min). In the recovery room, severity of pain and agitation were assessed by an investigator blinded to the assigned group. Time to eye opening and incidence of severe pain and agitation were compared between groups. Logistic regression was used to identify factors related to occurrence of severe pain and agitation.
RESULTS
Number of patients with severe postoperative pain was 6 and 16 in groups N and R, respectively (P = 0.012). Incidence of emergence agitation was not significantly different between groups. Remifentanil infusion was a significant factor related to the occurrence of severe postoperative pain (P = 0.015), and age was inversely related to occurrence of emergence agitation (P = 0.001).
CONCLUSIONS
In children undergoing tonsillectomy/adenoidectomy, intraoperative remifentanil infusion may increase incidence of severe postoperative pain compared to N2O, but it may not affect incidence of emergence agitation.

Keyword

Agitation; Pain; Pediatric; Postoperative; Remifentanil; Tonsillectomy

MeSH Terms

Aged
Anesthesia, General
Child
Dihydroergotamine
Eye
Humans
Incidence
Logistic Models
Methyl Ethers
Pain, Postoperative
Piperidines
Recovery Room
Research Personnel
Tonsillectomy
Dihydroergotamine
Methyl Ethers
Piperidines