Yonsei Med J.  2012 Sep;53(5):1014-1021.

Remifentanil Use in Pediatric Scoliosis Surgery-An Effective Alternative to Morphine (A Retrospective Study)

• Abu-Kishk
• Hod-Feins
• Anekstein
• Mirovsky Y
• Barr J
• Lahat E
• Eshel G

Abstract

PURPOSE
The unique properties of remifentanil make it ideal for pediatric use despite a lack of wide randomized clinical trials and fear of adverse events due to its high potency. We aimed to consolidate preliminary conclusions regarding the efficacy of remifentanil use in pediatric scoliosis surgery.
MATERIALS AND METHODS
The medical charts of children with idiopathic scoliosis who underwent primary spinal fusion between 1998 and 2007 at a large tertiary university-affiliated hospital were retrospectively reviewed and divided into two groups according to anesthetic regime (remifentanil vs. morphine). Demographic, surgery-related details and immediate postoperative course were recorded and compared.
RESULTS
All 36 remifentanil children were extubated shortly after termination of surgery, compared to 2 of the 84 patients in the morphine group. The remaining patients in the morphine group were extubated hours after surgery [5.4 hours; standard deviation (SD) 1.7 hours]. Six remifentanil children were spared routine intensive care hospitalization (vs. 2 morphine children-significant difference). Shorter surgeries [5.6 hours (SD 1.82 hours) vs. 7.14 hours (SD 2.15 hours); p=0.0004] were logged for the remifentanil group. To achieve controlled hypotension during surgery, vasodilator agents were used in the morphine group only. A comparison of early postoperative major or minor complication rates (including neurological and pulmonary complications) between the two groups yielded no significant differences.
CONCLUSION
Remifentanil use can shorten operating time and facilitate earlier spontaneous ventilation and extubation, with less of a need for intensive care hospitalization and no increase in significant complications.

Keyword

Remifentanil; morphine; idiopathic scoliosis; ICU; postoperative complications and ventilation

MeSH Terms

Child
Critical Care
Hospitalization
Humans
Hypotension, Controlled
Morphine*
Retrospective Studies*
Scoliosis*
Spinal Fusion
Vasodilator Agents
Ventilation
Morphine
Vasodilator Agents

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